Facility Evaluation Report

On 10/29/2024, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA met with Administrator Jesusa Nagtalon. LPA Lee explained the purpose of today’s visit. Administrator Jesusa assisted with today’s inspection. Administrator Certificate # is 7033239735 and expires on 04/18/2026. The current census is 1 with 2 facility staff.

This facility is a single story building licensed to served three (3) ambulatory and one (1) non-ambulatory client. LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, client bedrooms, clients’ bathrooms, laundry room, staff room, garage and outside courtyards of the facility to ensure compliance with Title 22 regulations. It was observed the facility was free of odor, clean and in good repair. LPA observed client bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present.

LPA toured the kitchen and observed the facility had sufficient seven day non-perishable food supplies and 2 days perishable food supplies. Hot water temperature was measured at 111.2 degrees Fahrenheit in client bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in the kitchen and was last serviced on 10/22/2024. The last fire drill was conducted on 10/01/2024. LPA observed the facility has a has a public telephone in the common area. Facility thermostat observed at 72 degrees Fahrenheit. LPA observed toxins located in the garage cabinet kept locked and inaccessible to clients. LPA observed sharp knives kept locked and inaccessible to clients. LPA checked medication storage and found medication to be locked away and inaccessible to clients. LPA reviewed and compared 1 out of 1 medication administration record (MAR) along with client medications and it was all complete. LPA asked to inspect the facility’s first aid kit and it was complete. LPA requested client and staff files for review. LPA reviewed 1 out of 1 client file and they were complete. LPA reviewed 2 staff files and they were complete.

As a result of this annual visit, the facility is in compliance with Title 22 Regulation, and no deficiencies were cited. An exit interview was conducted, and a copy of these LIC 809 reports were provided to the facility.