Facility Evaluation Report

Licensing Program Analyst (LPA) Jenifer Tirre visited this facility for the purpose of conducting a Change of Ownership Pre-Licensing evaluation. During visit LPA observed five residents in care. Facility is a single story residential home. LPA along with Licensee Maricel Neponuceno, Administrators Diane Mahinay and Jeff Bencito toured facility at 10:05AM and observed the following:

Fire clearance approval was received on 06/24/24. Structure: Facility is a one story, 4 bedroom (two private bedrooms and two shared bedrooms) and four bathrooms house with attached garage and a beige exterior. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Residents: All Residents bedrooms meet Licensing requirements. Bathrooms: resident bathrooms have a working toilet, wash basin, and bathtub/shower as well as grab bars and non-skid surface mats in the shower. Linens & Hygiene Supplies: Facility has adequate supply of linens, blankets and towels. Facility has hygiene products for each resident. Emergency Phone Numbers and Exit Plan: Facility has Emergency Plan posted on wall. Food Service: Facility has adequate supply of 2 day perishables as well as 7 day non-perishables in the pantry/ refrigerator, as well as ample emergency food and water supply. Smoke Detectors: Smoke detectors/ carbon monoxide detector are centrally wired and were tested operational. Facility has one fire extinguisher. Fire extinguisher is mounted and fully charged. Facility has audible alarms on all sliding/exit doors. Appliances: Facility has operating gas stove, refrigerator, microwave,washer and dryer. Toxins : LPA observed toxins secured in laundry storage area and Sharps secured in locked drawer. Water Temperature: Tested and recorded between 114.6 to 116.4 degrees F. in facility bathrooms. Reading Material Games, and Equipment:

facility does exercises, music therapy, puzzles, games, books and coloring books. Medications, First-Aid Kit & Book: Facility has first aid kit present at the facility with proper components. Facility has a secured location for medications and facility files. Backyard: LPA observed the facility perimeter is secured by wall with a self latching gate on both sides of facility as required. LPA observed shaded outdoor seating.