Facility Evaluation Report

On August 1, 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. Licensee (LI) Marison Pinili was notified via telephone and later arrived to assist with the inspection. LPA observed that Madison Pinili has a valid Administrator certificate which expires on November 28, 2026.

The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, of which one may be bedridden in bedroom #5, and has a hospice waiver for two. The facility is a single story home with four private resident bedrooms, one staff bedroom, three shared resident bathrooms, a living room, a dining room, a kitchen, and an attached two car garage. LPA, accompanied by the LI, conducted a tour of the interior portions of the facility. On today's visit, LPA observed four resident in care and two care giving staff present. LPA observed the See Something, Say Something poster, (PUB 475) mounted on the wall in the dining room. LPA inspected all four 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 three 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 114.4 to 114.9 degrees Fahrenheit. LPA observed the staff bedroom to be kept locked and inaccessible to residents in care.

LPA observed the kitchen has a two day perishable and a seven day non-perishable food supply on hand. LPA observed kitchen appliances to be clean and operational. CONTINUED ON LIC809-C