Facility Evaluation Report

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 Administrator (AD) Ester Dela Cruz after explaining the purpose for the visit. LPA observed that Administrator Ester Dela Cruz submitted a renewal application to the Administrator Certification Bureau (ACB) on April 7, 2025.

The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, and has a hospice waiver for five. The facility is a single story home with four resident bedrooms, two of which can be shared, one staff bedroom, three shared resident 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 portion of the facility. On today's visit, LPA observed four residents in care, three of which are on hospice, and four staff present. LPA observed residents relaxing in their respective bedrooms and in common areas. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the dining room. LPA inspected the four resident bedrooms and they were observed to be free of hazards. Resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds had clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA tested the individual smoke detectors in each of the resident rooms which tested operational. LPA observed the staff bedroom to be kept locked and inaccessible to residents in care. LPA inspected the three resident bathrooms and they were observed to be clean. Resident bathrooms were equipped with grab bars and nonskid floor mats. Faucets and toilets were operational. Hot water temperature measured between 108.5 and 109.4 degrees Fahrenheit.