Facility Evaluation Report

Licensing Program Analysts, Kathrina Chin made an unannounced visit for a pre-licensing evaluation. LPA met with Shella Manalang, Applicant and Joshua Estrevillo, Administrator. The facility has five bedrooms and five and a half bathrooms and is a single story with a two car garage. The inspection is as follows:

A fire clearance was granted on September 20, 2021 for one ambulatory and 3 non-ambulatory of which one may be bedridden. The facility has submitted a hospice waiver request for 2 residents.

LPAs toured the facility, interior and exterior, including all resident bedrooms. Hot water were tested in a bathroom and observed to be 111.4 degrees Fahrenheit. Fire extinguishers were mounted and charged. Smoke detectors were centrally wired throughout and have been checked by the fire department. Carbon monoxide detectors are operational. There is a sufficient supply of linens. Bedrooms are appropriately furnished. There is sufficient lighting. There are non-skid mats in the showers.

There was one locked medication closet which stores one first aid kit. There were several locked closets for storage of toxins, cleaning equipment and PPEs in the garage. All exit has auditory devices. The kitchen area was checked and there is a sufficient supply of food items. There were emergency food supplies and water. LPA observed activity calendars, menu, theft and loss policy, residents rights, admission agreement, and emergency plans were posted including the Let Us Know poster. LPA reviewed the outdoor area and with outdoor furniture and a gazebo.

The Component III Orientation is waived as Shella Manalang is an existing facility operator. (Continued on LIC 809-C)