Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by caregiver staff and explained the reason for the visit. The House Manager (HM) Irish Tacsuan arrived shortly to assist with the visit. The facility is licensed for five non-ambulatory residents of which one may be bedridden with a hospice waiver for four. Currently there are three residents, of which one is on hospice during today's visit.

LPA Tea reviewed three resident files and four staff files. Staff files contained all required documentation. There are some discrepancies with resident files. Upon review of records, the facility is up to date with required quarterly emergency disaster drills, which were last conducted in July 29, 2025. The administrator certificate expires May 31, 2025.

LPA Tea along with staff toured the facility. LPA toured the physical plant, checked the food service, and the first aid kit. The facility is a two-story home, the first floor consists of 3 resident bedrooms, 2 bathrooms, a living room, dining room, kitchen and attached garage. The second floor is only for staff where live in care staff resides, no residents reside on the second floor. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational, they are maintained and serviced through a third-party security company. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, and showers were free of mold/mildew. The water temperature measured around 106.5 Fahrenheit degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards; doorways were free (Annual continuation on LIC809-C)