Facility Evaluation Report

Licensing Program Analyst (LPA) Nune Margaryan conducted an Annual Required visit and inspection of the facility. LPA met with Licensee Adelaida Asuncion. LPA explained the purpose of the visit. During the visit, the CARE tool was used. The facility is licensed to serve Dementia residents, ages 60 and above, approved for two (2) non-ambulatory and four (4) ambulatory residents. Currently, there is no hospice resident in placement.

The facility is a single-story house located in a residential neighborhood. It consists of five (5) bedrooms including three (3) resident bedrooms, one (1) staff room, one (1) room for family member; three (3) bathrooms, kitchen, dining room, living room, and detached garage. Facility was toured, staff/residents files were reviewed. Residents medications were reviewed. No pools and bodies of water on the premises. All residents' bedrooms and bathrooms were inspected. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the backyard. The common areas are clean and have the required furniture. The resident bathrooms have the required grabs bars and non-skid mat. The water temperature was tested and was measured within Title 22 Regulation guidelines. Resident bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space.

The kitchen was inspected. LPA observed that kitchen equipment are in working condition. LPA observed sufficient supply of perishable and non-perishable foods. There is additional food in the refrigerators located in the garage. Adequate linen and personal hygiene supplies was observed. Auditory alarm devices to monitor exits were operable.