Facility Evaluation Report

Licensing Program Analyst (LPA) Jenifer Tirre visited this facility for the purpose of conducting a Pre-Licensing evaluation. Facility is a single story residential home. LPA along with Licensee Maricel Nepomuceno and Administrator Justin Duclayan toured facility at 3:45 PM and observed the following:

Fire clearance approval was received on 09/17/24. Structure: Facility is a one story, 6 bedroom (4 private Residents bedrooms, 1 shared resident bedroom and 1 staff room area) 5 full bathrooms house with detached garage and a beige exterior. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Residents: All Residents bedrooms meet Licensing requirements. Bathrooms: All resident bathrooms have a working toilet, wash basin, and bathtub/shower as well as grab bars and non-skid surface in the shower. Linens & Hygiene Supplies: Facility has adequate supply of linens and towels. Emergency Phone Numbers and Exit Plan: Facility has Emergency Plan posted on wall and operating landline Food Service: Facility has 2 day perishables as well as 7 day non-perishables in the pantry/ refrigerator, as well as emergency food and water supply. Smoke Detectors: Smoke detectors and carbon monoxide detector are centrally wired and were tested operational. Facility has 3 Fire extinguishers which are mounted and charged. Facility has audible alarms on all sliding/exit doors. Appliances: Electric Stove and refrigerator are operational. Toxins : LPA observed toxins secured in laundry storage area. Sharps are secured in drawer. Water Temperature: Tested and recorded between 108.5 to 111.7 degrees F. in facility bathrooms. Reading Material Games, and Equipment:

facility does exercises, puzzles, bingo and has activity directors. Medications, First-Aid Kit & Book: Facility has first aid kit present at the facility. Facility has a secured location for medications and facility files. Backyard: LPA observed the facility perimeter is secured by wall with a self latching gate on both sides of facility as required. LPA observed shaded outdoor seating and golf green area. Backyard has outside covered Jacuzzi that is non operational.