Facility Evaluation Report

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Dory Lacwasan. Administrator (AD) Cherry Aguila arrived at approximately 1:40 p.m. and the purpose of the inspection was discussed.

During the inspection, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following:

This is a one-story home with four resident bedrooms, three bathrooms, and attached two-car garage. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. LPA observed four resident beds with full bed rails. One of four resident files did not include a written physician order for the use of full bed rails. LPA also observed one of five residents sitting in their wheelchair with the use of a lap belt and AD was unable to provide LPA with a written order from a physician indicating the need for the postural support; a Deficiency was cited on today’s date. The backyard has a shaded sitting area. LPA observed residents watching television in the living room and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew and faucets and toilets were operational. Water temperature tested between 116.9-117.6 degrees Fahrenheit. LPA observed that the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged. Gas stove, microwave, laundry washer and dryer were all inspected and observed to be operable. Medication cabinet was observed to be locked. (Cont. LIC809-C)