Facility Evaluation Report

Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced required visit to the facility for the purpose of conducting the required annual inspection. LPA Rodriguez explained reason for visit and was greeted and granted entry by staff on duty. During the visit, staff on duty contacted facility administrator (AD) Rizalina Reyes about visit. For this visit, there are three staff members on duty, of which are background cleared and associated.

The PUB475 "See Something, Say Something" poster was observed to be located in the kitchen. LPA observed the Administrator's Certificate for Rizalina Reyes which expires on 6/30/2027.

LPA toured the interior and exterior portions of the facility with AD Reyes. The facility is a two-level structure and is licensed for 6 residents, of which 6 may be non-ambulatory, 0 may be bedridden and 4 may be on hospice. For this visit, there are a total of 5 residents in care, of which 4 are on hospice and 0 are bedridden.

On the first floor, there are a total of 4 resident bedrooms, of which 2 are private resident rooms, and 2 are shared resident rooms. LPA 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 2 restrooms on the first floor. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature was measured to be at 109.9 degrees Fahrenheit.