Facility Evaluation Report

Licensing Program Analyst (LPA) Christina Valerio arrived announced to conduct the Pre-Licensing Visit and complete Component III. LPA Valerio met with Licensee/Administrator Ezra Paulo Estepa and Co-Licensee Georgina Manipud, and explained the purpose of the visit.

The facility has an approved fire clearance to service individuals aged 18 to 59 of age, approved for three (3) ambulatory residents, and approved for one (1) non-ambulatory resident, which may live in bedroom #4 only. LPA Valerio reviewed the facility's Emergency Disaster Plan and Infection Control Plan. No concerns were observed.

LPA and Licensee conducted a walk-through of the physical plant inside and out to ensure compliance with Title 22 regulations. LPA observed resident bedrooms to be fully furnished, clean, and organized. All bedroom doors were observed to have a lock. Resident bathrooms were observed to be stocked with hygiene supplies, a trash can, skid mats, and hand rails. The facility will obtain a hoyer lift. Common areas were fully furnished. LPA Valerio observed where medications, cleaning supplies, files, and sharps will be locked and inaccessible to residents. Exterior areas were observed to be furnished with areas for outside activities. No emergency exits were obstructed. Fire extinguisher, Carbon Monoxide detectors, and fire extinguisher were in working condition. All ramps were observed to be in compliance and sturdy.

Component III was conducted and completed with Licensees. Licensees/Administrator had no further questions.

Pre-Licensing is complete and this facility has no deficiencies. An exit interview was held, and a copy of this report was provided.