Facility Evaluation Report

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator Dianna Manalo and explained the reason for the visit. The Administrator's certificate expires November 15, 2025. The facility is a single story home that has 5 bedrooms and 2 bathrooms, activity room, dining room, kitchen and a 2 car garage. Facility is licensed for a capacity of 6 non-ambulatory residents and a hospice waiver for 4. LPA and Administrator toured the facility. LPA observed the see something say something poster (PUB 475) posted in the entry way of the facility. LPA observed that the resident bedrooms are clean and organized. LPA observed all the resident bedrooms had the required furnishings. . LPA observed both bathrooms are clean and operational. Hot water measured 111.9 degrees Fahrenheit in both bathrooms. Smoke detectors/carbon monoxide detectors tested operational. The last emergency drill was conducted on April 18, 2025. The fire extinguisher in the kitchen is fully charged. LPA observed the kitchen is clean and organized. LPA observed a two day perishable and seven day non-perishable food supply on hand in the kitchen. LPA observed the knives and sharp objects are kept locked in a kitchen drawer and the cleaning supplies are kept locked under the kitchen sink. The activity room has 4 reclining chairs and a sofa. There is also a TV in the activity room. Medications are kept locked in the cabinet in the dining room. The garage is inaccessible to residents and kept locked. The garage is used for storage of supplies and furniture. LPA observed a 3 day emergency food and water supply stored in the garage. LPA and the Administrator toured the backyard. Both exit gates are operational. No bodies of water observed. LPA reviewed 4 staff files. LPA observed that 1 out of 4 staff files (Staff 3) did not have 8 hours of the required Dementia training. No other discrepancies observed. LPA reviewed 6 resident files and medications, no discrepancies observed.