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 staff after explaining the purpose of the visit. LPA was assisted by caregiver Edison Canlas and later assisted by caregiver Giselle Enebrad who later arrived. LPA observed the administrator certificate was current with an expiration date of June 18 ,2027. This is a Residential Care Facility for the Elderly (RCFE) licensed to six non-ambulatory residents, of which one may be bedridden, with a hospice waiver for six. The facility is a one-story home with five resident bedrooms, three bathrooms, living room, kitchen, dining room and an attached garage.

During the inspection, LPA and caregiver conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following:

LPA observed residents watching television in their respective bedrooms. LPA observed four residents in care and two staff present. LPA observed the See Something Say Something Poster (PUB 475) mounted on the entryway. LPA observed that all resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets with additional linens stored in the hallway storage closet. LPA observed bathrooms were clean and equipped with grab bars, toilet paper, paper towels, and non-skid floor mats. Bathrooms were observed to be free of debris and mildew. Faucets and toilets were operational. Water temperature tested between 103.3 and 114.6 degrees Fahrenheit. LPA observed all windows were appropriately screened. 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.