Facility Evaluation Report

On 12/27/2023 at 9:45am, Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced annual required visit, with the use of the CARE Inspection Tool. LPA initially met with a staff on duty and explained the purpose of today’s visit. The facility administrator, Angelita Dayoan, was informed of the visit and arrived shortly after. The facility is currently licensed to serve 6 non-ambulatory elderly residents of which 1 may be bedridden. The facility is approved for 4 hospice residents. Currently, the facility has 3 hospice residents in care. Room #4 is cleared for bedridden residents. Present during this visit, there were 6 residents in care with 2 staff on duty.

At 10.15am LPA inspected the facility’s physical plant with the administrator including but not limited to the kitchen, dining room, resident bedrooms, resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. The facility is a one-story structure located in a residential neighborhood. There were no bodies of water on the premises. Outside of the facility was observed to be cleaned and clear of obstructions. Additionally, LPA observed outdoor furniture for residents’ use and covered area for outdoor activities. Entrance, exits and hallways were observed to be clear of obstructions. LPA observed 6 private resident bedrooms and 3 bathrooms for resident use. One of the bedrooms has its own bathroom. LPA observed beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage for the resident's personal belongings. Bed linens, comforters, and bath towels were adequately stocked during the visit. Bathrooms were operational and adequately supplied including with grab bars and non-skid flooring.