Facility Evaluation Report

At 10:10 AM, Licensing Program Analyst (LPA) Huma Rahimi arrived at this facility to conduct a Required Annual Inspection. LPA rang the bell and no one responded. LPA called the facility's phone number and no one responded. LPA contacted the Administrator and left a voicemail. LPA knocked the facility's door and waited for additional ten (10) minutes. At 10:25 AM, the Administrator Jacob Pascasio granted access to LPA. LPA explained the reason for the visit. At 10:35 AM, LPA and the Administrator toured the facility and observed the following:

The facility is a single story building with four (04) bedrooms, two (02) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 5 non-ambulatory clients. Facility is operating level 4 clients.

Kitchen: At approximately 10:36 AM, LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. Facility stores the knives, sharps, first aid kit, emergency supply of food and water, client's medications and facility records in a locked cabinet by the kitchen. LPA observed two (2) fire extinguishers one (1) is located by the kitchen and the second is in a hallway fully charged with a serviced date of 03/12/2025.

Bedrooms: LPA observed total of four (4) bedrooms designated for clients use. All bedrooms are properly furnished, clean and have appropriate bedding and linens.

Bathrooms: LPA observed two (2) bathrooms and both appeared to be clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and client's bathroom had non-skid mat. Hot water temperature measured at 111.4°F. Continue on LIC809-C