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 Assistant Administrator Rachel Tutop. and explained the reason for the visit. The Administrator's, Loida Angeles, Administrator's Certificate, expires on March 29, 2026. The facility is licensed for 6 residents of which 4 can be non-ambulatory and approved for 1 bedridden (bedroom 2) and a hospice waiver for 3. 5 residents were present at the time of the visit and 3 are on hospice. LPA and the Administrator toured the facility. Facility is a single story house with 7 bedrooms (1 bedroom is for staff), 5 bathrooms, kitchen/dining room, living room and a 2 car garage that is being used for storage. LPA observed the See Something, Say Something sign (PUB 475) posted on the kitchen wall. LPA observed all resident bedrooms have the required furnishings. LPA observed extra linens stored in the hall closet. LPA observed all the bathrooms are clean and operational. Hot water measured 115.1 to 116.0 degrees Fahrenheit in all bathrooms. Smoke detectors and carbon monoxide detectors tested operational. LPA observed the fireplace in the living room is screened and needs a key to operate, the key is kept locked. LPA observed the fire extinguisher in the dining room is fully charged. LPA observed a 2 day perishable and a 7 day non-perishable food supply in the kitchen. Knives are kept locked in a kitchen drawer. Medication is kept locked in a dining room cabinet. The kitchen is clean and organized. LPA observed the right front burner of the 5 burner gas stove does not light. The garage is kept locked and used for storage. LPA observed old furniture stored in the garage. LPA and staff toured the backyard. No bodies of water observed. There is a table with 4 chairs and an umbrella for residents to sit outside. No obstacles or hazards observed in the backyard. LPA reviewed reviewed 5 resident files and medications, no discrepancies observed. The facility has a laptop computer with internet access for resident use only.