Facility Evaluation Report

On 01/21/2026, Licensing Program Analysts (LPAs) Beena Singh and Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPAs met with staff/care giver Titus Irangus and was granted entry to the facility. At the time of the visit there were one (1) staff present, and three (3) residents present. LPA Singh explained the purpose of the visit to staff/care giver Titus Irangus.

The facility is a five (5) bedroom, two (2) bathroom home with a kitchen/dining area, living room, laundry area and garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which six (6) can be non-ambulatory residents. The facility has two (2) Hospice Waiver. The current census is four (4) residents. LPA was accompanied by staff/care giver Titus Irangus conduct a general overall inspection, which included, but was not limited to, the following:

Physical Plant : The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). LPA observed no obstructions to indoor passageways. The facility is maintained at a comfortable temperature of 76 degrees Fahrenheit. LPAs inspected resident bedrooms; they are equipped with required furniture such as: mattresses, and storage space, lamps and chairs and sufficient lighting in the bedrooms. During the walk through, LPAs observed kitchen cabinet to be in despair. In addition, LPAs also observed no working lights in the laundry room. While inspecting facility garage LPAs observed a leakage coming from the water filter LPAs observed mold on the wall due to the leakage. LPAs will issue deficiency. Moreover, LPAs observed that bathrooms were clean, and appliances were operating appropriately. LPAs observed grab bars and non-skid mat in the resident bathrooms.