Facility Evaluation Report

Licensing Program Analysts (LPA) Jose Tan met with Administrator Rosario Soriano for a One (1) Year Required visit for this facility. LPA explained the reason for the visit.

A tour of the physical plant was conducted at 1:02 PM and the following was noted:

There is only one entrance being utilized at the facility. The facility had submitted and approved Mitigation plan. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the garage.

The facility has five (5) bedrooms and three (3) bathrooms currently occupying six (6) residents. One (1) additional bedroom is designated for staff use. The facility is fire cleared for six (6) non-ambulatory residents, Hospice waiver for two (2) residents.

Living and dining room furniture were also checked. The living room is neat and clean along with the family room. The facility maintains a comfortable temperature at 72°F. The smoke detectors are hardwired and interconnected and observed to be operational. There are carbon monoxide installed at the facility. Fire extinguisher is located in the kitchen and observed to be full and last checked on 02/21/26.

The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. There is an structure at the backyard being used as old equipment storage and was observed to be locked during the visit. There is no body of water at the facility. (continued on LIC 809-C)