Facility Evaluation Report

Licensing Program Analyst (LPA) Nancy Guillen made an unannounced visit for the purpose of conducting a required annual Inspection. LPA was greeted and granted entry by care provider Ace Reblora after explaining the purpose of the visit. Administrator (AD) Carina Demman was notified via telephone and later arrived to assist with record review. LPA observed the Administrator certificate was current and expires December 12, 2025. This is a Residential Care Facility for the Elderly (RCFE) licensed to six non-ambulatory residents with a hospice waiver for three. The facility is a one story home with three resident bedrooms, one staff bedroom, two bathrooms, kitchen, living room, dinning room, office space, and an attached garage.

During the inspection, LPA and caregiver conducted a tour of the inside and outside of the facility and observed the following:

LPA observed residents watching television in the living room. LPA observed four residents in care and three staff present. LPA observed the See Something Say Something Poster (PUB 475) mounted on the wall by the facility entrance. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets with additional linens stored in the hallway storage cabinet. LPA observed bathrooms were clean and equipped with grab bars and non skid floor mats. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 106.7 and 109.5 degrees Fahrenheit. LPA toured the outside of the facility and observed outdoor passageways were free of obstruction. LPA observed the backyard had a shaded sitting area with furniture for resident use.