Facility Evaluation Report

On 12/03/25 at 1:15 p.m., Licensing Program Analyst (LPA) Sommer Hayes arrived at this facility unannounced to conduct a post-licensing inspection. LPA Hayes arrived and was met by facility staff and later met with Administrator/Licensee Marilyn dela Cruz and explained the purpose of the visit.

There are currently two (2) residents living at the facility. LPA toured and inspected the physical plant inside and outside with administrator to ensure there were no health and safety concerns. LPA observed the kitchen, bedrooms, bathrooms, and common areas. LPA observed the facility is in good repair. LPA observed sufficient furniture and lighting throughout the facility. LPA observed the rooms to be clean and organized with proper furnishings. The hot water temperature was measured at 119.2 Fahrenheit. The temperature inside the facility measured at 71 degrees Fahrenheit which was within the required range of 68-85 degrees Fahrenheit. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. LPA observed the centrally stored medication areas to be secured and inaccessible to the residents at this time. LPA observed the fire extinguisher(s) and first aid kits were up to date. LPA observed smoke and carbon monoxide detector(s) in the facility were in good repair. LPA observed the following posted in the entrance of the facility. See Something Say Something poster, Ombudsman poster, Resident Personal Rights, Evacuation Routes and facility license was all posted as required. LPA reviewed 2 out of 2 resident files and 2 staff files. LPA confirmed that residents’ files have the required documents. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility.

As a result of this post-licensing visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted, and a copy of the LIC 809 report was given to Administrator/Licensee Marilyn dela Cruz.