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 Administrator/Caregiver Maricel Guibilondo and explained the reason for the visit. Administrator (Admin) Guibilondo holds a valid certificate expiring on November 12, 2025.

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 5 may be bedridden. A waiver was granted to provide hospice services to five residents at one time. During today's visit, there are four residents under hospice care and two staff on duty.

LPA toured the physical plant with Admin Guibilondo. Facility is clean and operational with the exception of the keypad lock on the garage door. LPA observed six resident bedrooms/bathrooms. There is one additional staff bedroom and bathroom. Resident bedrooms had all required furnishings. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 118.4, 117.5, 119.8, 118.5, 120.0, and 119.6 degrees Fahrenheit in the resident bathrooms. All common areas were inspected including the attached two car garage. LPA reviewed the Emergency Disaster Plan (LIC610E) and observed sufficient emergency food and water in the garage and kitchen pantry, however not all disaster supplies were obtained as noted on the LIC610E. 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. The exit gates were self-closing and self-latching. LPA observed sufficient seating and shading.