Facility Evaluation Report

On 03/22/2022 at 8:50 AM, Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct an annual inspection visit. Prior to entering the facility, LPA Truong attempted to contact the facility. Upon LPAs arrival, Caregiver Constante Duldulao was present at facility and contacted Administrator Rochelle H. Cister who arrived a bit later. LPA met with Administrator Rochelle H. Cister and explained the purpose of today’s visit.

Administrator holds current certification #6050060735 and expires on 11/26/2022. The facility is licensed for 4 ambulatory residents of which 1 is non-ambulatory. There is currently 4 residents who reside at this facility. LPA toured the facility with the administrator, Rochelle H. Cister, on 03/22/2022 at 9:25 AM.

LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA also conducted the infection control domain tool.

LPA observed sufficient furniture and lighting throughout the facility. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. The hot water temperature was observed to be 119 degrees Fahrenheit, which is within the required regulation of 105 to 120 degrees Fahrenheit. Facility thermostat observed at 70 degrees Fahrenheit. Food supply is adequate for 2-day perishable and 7-day nonperishable.