Facility Evaluation Report

On today's date Licensing Program Analyst (LPA) William Vanegas conducted an unannounced visit for the purposes of completing an annual inspection. Upon arrival LPA was greeted and granted entry into the facility by facility staff. LPA explained the purpose of the visit, and Administrator (AD) Philippem Delacruz was notified via telephone. AD arrived shortly after to assist LPA with annual inspection. LPA began a tour of the facility accompanied by AD. LPA observed the following AD has a valid Administrator certificate valid from September 25, 2025 to September 24, 2027.

The facility is a one storied home equipped with six bedrooms four of which are for clients in care and two of which are utilized for staff on duty. The facility is equipped with two and a half bathrooms, all of which are shared. The facility is equipped with an attached two car garage. LPA observed kitchen are to be clean and free of any mildew and debris. LPA observed kitchen are to have a dishwasher, microwave, gas stove, and refrigerator. All tested operational and appeared to be in good repair. LPA observed the facility to have a two day supply of perishable food and a seven day supply of non-perishable food. LPA observed a sufficient amount of emergency water on hand as well.

LPA observed all resident bedrooms to be large enough to walk about freely and accommodate required furnishings. LPA observed all bedrooms to have all required furnishings including the following: A chair, a reading lamp, a chest of drawers, a bed, clean linens in good repair; meaning no strains or tears, and enough storage space to store personal belongings. LPA observed all bathrooms to have all required furnishings such as a shower chair, grab bars, and slip resistant floor matts. LPA observed water faucets and toilets to test operational. LPA observed hot water temperature to be between 108.5 and 109.2 degrees Fahrenheit. CONTINUED ON LIC809-C