Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Coloma Cottage. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the home and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents, one of which may be bedridden. Facility has an approved hospice waiver for 6 residents and the home currently has 1 resident on hospice during today's visit. Maureen Salonga has an Administrator Certificate expiring on 10/24/2026. Caregiver Audi Baldonasa and Administrator Maureen Salonga arrived during the visit.

LPA along with Caregiver Baldonasa toured the facility at 11:10 AM. LPA toured the physical plant, checked food service, and the first aid kit. Facility appears clean and sanitary upon entrance. The home consists of four resident bedrooms, one resident bathroom, one shared hall bathroom, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed four residents with half bed rails. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 105.9 and 107 degrees F in all facility bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Resident hygiene supplies are locked and inaccessible to residents. Common areas were clean and clear of hazards. First aid kit had all the required elements including tweezers, thermometer, and scissors. During today's visit, auditory door alarms are operational. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and Carbon Monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and exit gates are unlocked and self latching. CONT ON LIC 9099C DATED 03/03/2026