Facility Evaluation Report

Licensing Program Analyst (LPA) Jessica Cho arrived 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 Lian Tjia and explained the reason for the visit. Administrator (Admin) Anthony Coloma arrived on premise to assist with the inspection. Admin Anthony holds a valid certificate expiring on November 25, 2025 and October 24, 2025 for Administrator Maureen Salonga.

The facility is a single story structure and is licensed to provide services for age range 60 and over for six non-ambulatory, of which one may be bedridden in bedroom #1. Facility can provide hospice services to six residents at one time. During today's visit, there are two out of six residents under hospice care and three caregivers on duty.

LPA toured the physical plant with Admin Anthony and Lead Staff Marianne Salonga. LPA observed five resident bedrooms and three resident bathrooms. Resident bedrooms had all required furnishings. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 109.0, 108.3, and 108.1 degrees Fahrenheit. All common areas were inspected including the attached two car garage. LPA observed sufficient emergency food and water. Disaster supplies indicated on the Emergency Disaster Plan (LIC610E) were not maintained. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food available in the kitchen and garage. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. Both exit gates were self-closing and self-latching. LPA observed sufficient seating and shading. The fire extinguisher was mounted and serviced in March 2025. The auditory devices and smoke/carbon monoxide detectors were tested and operational.