Facility Evaluation Report

On October 7, 2025, Licensing Program Analyst (LPA) Garlli Tat conducted an unannounced visit to the facility for the purpose of a required annual inspection. LPA explained the purpose for the visit and was greeted and granted entry by staff on duty. During the visit, staff on duty notified the facility administrator (AD) Marites Villanueva about the visit. For this visit, there are two staff members on duty, both of which are background cleared and associated. Designee Soledad Larcia, assisted with the inspection.

The PUB475 ‘See Something, Say Something’ poster was observed to be located by the front entrance. LPA observed the Administrator's Certificate for Marites Villanueva, which expires on December 12, 2025.

The facility is a Residential Care facility for the Elderly (RCFE) licensed for six residents, six of which may be non-ambulatory, none of which may be bedridden, and all of which may be on hospice. LPA toured the interior and exterior portions of the facility with Designee. For this visit, there are a total of four non-ambulatory residents in care and none are on hospice.

The facility is a single-story home. There are a total of five bedrooms, two are private resident rooms, two are shared resident rooms, and one serves as staff quarters. LPA toured each bedroom with the Designee and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and free of any hazards. LPA observed the staff quarters to be kept locked and inaccessible to residents in care. Smoke and carbon monoxide detectors as well as auditory exit alarms were tested. Auditory exit alarms were operational. However, LPA observed that the carbon monoxide alarm only had two batteries when three are necessary for it it operate properly. LPA also observed Staff 2 replaced the smoke detector when it was not working properly during the test. Continued on LIC 809-C.