Facility Evaluation Report

At approximately 8:30AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required 1-Year Visit, Upon arrival, LPA rang the doorbell and knocked on the door multiple times. LPA contacted Licensee at approximately 8:40AM and explained that they have been waiting to be let into the facility to conduct the visit. Licensee stated they will call the house. At approximately 9:00AM, LPA was greeted by staff members, Breana Chargualaf and Sheaena Hocog. Per staff members, they usually get the residents ready for the day around this time and apologized for the wait. Facility is a Residential Home for the Elderly and provides care and assistance for Older Adults. Facility has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance and capacity for 6 non-ambulatory residents. Facility has an approved hospice waiver for 6 individuals. Upon arrival, LPA was informed that there were 6 residents in care, and 3 staff members on-site. Licensee, Harry Van Meines, arrived during visit at approximately 11:50AM.

LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. LPA conducted a walk-though of the facility. LPA observed the following: Facility was found to be clean and at a comfortable temperature. Facility had emergency lighting. Facility is a one story residence with 5 resident bedrooms, two and a half bathrooms, two staff rooms, and common areas. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for Residents. Mattress pads were in place or available for Resident use. Hot water temperatures for all facility sinks were found to be within Title 22 Regulations of 105 to 120 degrees Fahrenheit. Fire extinguisher was last inspected December 2025. Facility's last emergency/disaster drill was conducted June 2026. Facility's emergency disaster plan and infection control plan were last reviewed and updated May 2025. Facility was observed to have enough water available in the event facility had to shelter in place for 72 hours.