Facility Evaluation Report

On March 19, 2026, at 1:15PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Caregiver (CG) Lourdes Manunay. Around 1:40 PM, LPA Kim spoke with Administrator (ADMIN) Mike Adams over the phone and explained the purpose of the visit. ADMIN Adams stated they could not attend today’s visit because they were out of the country and that CG Manunay could sign on behalf of the facility. LPA also spoke with ADMIN Adams about past due licensing fees and a current balance of $4947.00. ADMIN stated they will pay the Licensing Fee, but did not provide when.

The facility is licensed to operate for six (6) nonambulatory residents and has a hospice waiver for five (5) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, two (2) staff bedroom, three (3) bathrooms, living area, foyer, dining area, kitchen, outdoor covered patio, and a detached two car garage. The prior year, there was a walk-in closet next to the kitchen, but it was changed to be a second staff room. The facility sketch shows these two staff bedrooms were once one big staff room and that wall was not part of the original sketch.

LPA Kim toured inside and outside of the physical plant with CG Manunay. There were no bodies of water and no physical obstructions in the passageways. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be clean and operational. Resident bathrooms hot water temperature measured between 98.4 degrees F to 100.0 degrees F. A comfortable temperature of 78 degrees F was maintained in the facility.

Evaluation Report Continues on LIC 809-C .