Facility Evaluation Report

On 12/20/2024 at 9:35am, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced to this facility to conduct their required annual visit. LPA initially met with S1 and explained the purpose of the visit. The facility administrator, Gerwin Sicat was informed of the visit and informed is not able to come to the facility today and gave permission to staff on duty to sign this report. Present during this visit were 4 residents in care with 2 staff on duty (S1, S2).

LPA evaluated the physical plant with S1 to ensure the health and safety of the residents in care. Areas inspected include but not limited to the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas.

The facility is a one-story home located in a residential neighborhood. Facility is fire cleared to retain/admit 6 residents with approved hospice waiver for 3 residents. Facility has 6 bedrooms, 6 of which was approved for non-ambulatory. Facility has 3 bathrooms for resident use. 1 of which is located in the master bedroom.

LPA observed the facility to be free of odor, clean and in good repair at this time. LPA observed all resident bedrooms to be equipped with the required furniture and sufficient lighting throughout the facility. LPA inspected 3 of 3 bathrooms and were observed to be equipped with slip resistant flooring and overall in good repair at this time. Hot water temperature in 3 resident bathroom was measured between 116 and 119 degrees F. Room temperature was observed at 72 degrees F. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers were observed and were last inspected on 1/23/24. Smoke and carbon monoxide detectors were observed, 1 sample was tested and found operable. LPA observed centrally stored medications, toxins, and sharp objects were kept locked and inaccessible to residents in care. Fireplace was observed to be screened and non-operational at this time.