Facility Evaluation Report

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation using the CARE Inspection Tool. LPA was greeted and granted entry by Caregiver R S Kristian Umali after stating the reason for the visit followed by the live in House Manager (HM) Amelia Morales. The administrator's certificate for Theresa Kholoma is currently valid and expires on August 28, 2027.

The following was observed during the inspection:

This is a two story property located in a residential neighborhood. Facility operates within the conditions and limitations specified on the license. LPA observed six residents in care with two residents receiving hospice service. LPA observed two caregivers on duty and verified fingerprint clearance and association statuses. All common areas were inspected including the attached two car garage and the attic on the second floor which consisted of two private bedrooms for staff and one bathroom. On the first floor, LPA observed four resident bedrooms and two resident bathrooms. LPA observed the residents' bedrooms were appropriately furnished, beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage space for each residents' personal belongings were observed. There were no bed rail orders for five out of six residents per review of the resident files. All bathrooms were unclean and unsanitary evidenced by the feces in the toilet bowl in the private bathroom of Resident #1 (R1) and Resident #2 (R2), all bathroom sinks had hard water stains, rust, and pink stains as well as the dirty floor evidenced by the debris and particles. LPA observed staff cleaning the facility approximately 11am. The cold water temperature in R1 and R2's bathroom was not cool enough measuring at 82 degrees Fahrenheit. LPA observed Staff #2 (S2) not following the infection control practices as they did not remove their glove and wash their hands after changing a resident's brief prior to opening the kitchen cabinet.