Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Pacificare Home. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the home and met with Caregiver Aiza Clemente. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 3 residents and the home currently has 4 residents. There are 2 residents on hospice during today's visit. Emmelita Magdaluyo has an administrator certificate expiring on 09/22/2025.

LPA Lyman along with Caregiver Clemente toured the facility at 12:52 PM. LPA toured the physical plant, checked food service, facility records and the first aid kit. Facility appears to be clean, safe, and sanitary. The home consists of six resident bedrooms, two common restrooms, living room, dining room, office, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed three residents with half bed rails. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 105.8 and 108.3 degrees F in facility restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors. The entry door into the garage is secured. LPA observed a locked storage area for cleaning supplies and sharps under the kitchen sink. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and Carbon Monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample shaded seating for residents. Exit gate is unlocked and self latching. LPA observed emergency food and water supply in the garage. LPA reviewed the emergency disaster plan and infection control during the visit. CONTINUED ON LIC 9099C DATED 05/12/2025