Facility Evaluation Report

Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived for an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into facility by Administrator (AD) Felix Pesigan and Caregivers Helen Obligacion and Gloria Pesigan.

The facility is a one-story home with four resident bedrooms, two resident bathrooms, kitchen, dining room, living room, two staff rooms, one staff bathroom, back yard and attached two-car garage. LPA noted that the residents were away at day program during the inspection. All resident rooms had required elements, including bed, chair and closet space. Restrooms are stocked with soap and paper towels. Hot water measured at 120 degrees Fahrenheit in the bathroom nearest to the backyard and 116.2 degrees Fahrenheit in the bathroom nearest to the resident rooms. Facility has a supply of extra linen and hygiene supplies stored in cabinets in the hallway. LPA observed facility has emergency food and water supply. Garage has been converted into a lounge/activity space. Backyard has a seating area, basketball hoop and exercise equipment. There is an old bunny coop in the backyard that appears non-operational. Facility staff stated they will either refurbish it or get rid of it. There is a swing bench that is rusted. Facility staff moved the bench to the side of the house with no exit gate. Facility staff will either refurbish the bench or get rid of it. Medication, first aid kit and facility files are stored in locked cabinets near the dining area. LPA reviewed two out of four resident files, two out of four resident medication and three personnel files. LPA reviewed P&I money for all residents. P&I Money appeared to be accounted for and properly stored.

No deficiencies were noted during today's visit. An exit interview was conducted and a copy of this report was provided to the administrator.