Facility Evaluation Report

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced annual required visit. Upon entry, LPA was greeted by Gabriel Pagulayan, Caregiver, and informed them of the purpose of the visit. At the time of the visit, there was one (1) staff member and three (3) residents present. One (1) resident was attending the day program at the time of visit.

Facility Overview: The facility is a one-story home with four (4) bedrooms and two (2) bathrooms, including an attached garage. There are no pools or known firearms on the premises.

Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility has infection control plain in file.

Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 108°F. Fire extinguisher located next to laundry area has current inspection tag.

Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods.