Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to conduct the annual required visit. LPA was greeted and granted entry into the facility and explained the reason for the visit. Facility is licensed for 4 ambulatory clients. The facility currently has 4 clients. Divina Alipio has an Administrator Certificate expiring on 06/19/2026. The facility appears clean, safe and sanitary.

LPA Lyman along with Caregiver Apple Solis toured the facility at 12:30 PM. LPA toured the physical plant, checked food service, and reviewed facility documentation. The home consists of four client bedrooms, one shared hall bathroom, client restroom, living room, dining room, and kitchen. Client bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Client bathrooms were checked. Toilets and water faucets worked properly, and shower was free of mold/mildew. Water temperature measured between 106.8 and 112.8 degrees F in facility bathrooms. Client bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including thermometer, tweezers and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and Carbon Monoxide detectors tested operational during today's visit. Fire extinguisher is fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating for clients. Exit gates are unlocked, self latching and operational. LPA observed ample emergency food and water supply as well as emergency supplies. Facility provided documentation of last fire drill conducted on 07/01/2025 and drills are conducted quarterly. Facility provides activities in the form of games, exercise and outings in the community. LPA reviewed four client files and three staff files. Client files contained required documents including admission agreements, physician reports and client appraisals. Staff files reviewed contained required documentation of training, health screens/ TB and criminal record clearance. Staff files reviewed contained CPR certification. CONTINUED ON LIC 809C DATED 11/20/2025