Facility Evaluation Report

Licensing Program Analysts (LPAs) Celine Rodriguez and Garlli Tat conducted an unannounced visit for the required annual inspection. LPAs explained the purpose of today’s visit, and was greeted and granted entry by staff on duty (S1), and LPAs met with facility administrator (AD) Czarina Dumaliang about visit.

For today’s visit, LPAs observed a total of 4 residents in care and 2 staff members on duty, of which both staff members were background cleared and associated via Guardian.

LPAs observed the Administrator's Certificate for Czarina Dumaliang which expires on 3/10/2026. LPAs observed the PUB 475 "See Something Say Something" poster located at the entrance of the facility.

LPAs toured the interior and exterior portions of the facility with S1. The facility is a single level structure and is licensed for 6 non-ambulatory residents, of which 6 may be on hospice, of which 1 may be bedridden in room 3. There are a total of 6 bedrooms of which 4 are private resident rooms, 1 shared resident room, and 1 private room designated for staff. LPAs toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational.

There are a total of 5 restrooms in the facility. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature was observed to be 116.8 degrees Fahrenheit.