Facility Evaluation Report

On July 25, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Administrator (AD) Ma Dinah Dela Cruz was notified via telephone and later arrived to assist with the inspection. LPA observed Ma Dinah Dela Cruz submitted an Administrator renewal application to the Administrator Certification Bureau (ACB) on May 5, 2025.

The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for two. The facility is a single story home with three resident bedrooms, two staff bedroom, three bathrooms, a living room, a dining room, a kitchen, and an unattached two car garage. LPA, accompanied by the AD, conducted a tour of the interior portions of the facility. On today's visit, LPA observed two resident in care and two staff present. LPA observed residents relaxing in their respective bedrooms. LPA observed the See Something, Say Something poster, (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected all three resident bedrooms and observed them to be free of hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA inspected the two shared resident bathrooms and observed them to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 118.9 to 119.6 degrees Fahrenheit. LPA observed the two staff bedroom to be kept locked and inaccessible to residents in care.

LPA observed the facility has a two day perishable and a seven day non-perishable food supply on hand. CONTINUED ON LIC809-C