Facility Evaluation Report

On 09/19/25, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Annual Visit to the facility listed above. LPA met with Administrator, Kristina Lacanilao, and the purpose of today's visit was explained. LPA was granted entry into the facility. The facility is licensed to serve six (6) non-ambulatory residents aged 60 and over, two of which may be bedridden and has an approved hospice waiver for three (3). Currently there are 5 residents residing in the facility.

Physical Plant/Structure The facility is a single-story structure in a residential neighborhood. The facility consists of five (5) bedrooms, two (2) bathrooms, living room, dining room, kitchen, front yard, backyard, and garage. The front and backyard are landscaped and maintained. LPA observed a shaded patio in the backyard with table and chairs. All ramp railings are secured. All walkways outside were observed clean, clear, and free of debris, hazards, and obstructions. LPA did not observe any bodies of water on the property.

Bedrooms LPA inspected all bedrooms and found them to be clean and in good repair. LPA observed all bedrooms have the required furniture including a bed(s), dresser(s), chair(s), nightstand, and storage space for resident's personal belongings. All beds were observed with the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillows. LPA observed an ample supply of linens in a cabinet in the hallway in good repair. All rooms were observed to have ample lighting.

Bathrooms LPA inspected the bathrooms in the facility. All bathrooms were found to meet Title 22 regulations. Showers had secured safety handrails, nonskid mats, and shower chairs available. LPA observed an ample supply of hygiene products stored in a cabinet under the bathroom counter and are inaccessible to residents. Cleaning products were observed secured in a locked cabinet under the bathroom sink. LPA observed an ample supply of towels stored in a cabinet in the hallway. The water temperature measured 111.2- degrees and 112.3- degrees Fahrenheit.

Kitchen LPA inspected the kitchen and found it to be clean and sanitary. All appliances were observed in