Facility Evaluation Report

On 11/15/2025 at 9:00AM Licensing Program Analyst (LPA) Renese Howell-Small made an unannounced visit to the facility to conduct the required annual inspection. LPA met with Administrator, Geertruida Pangalila and Jantje Pangemanan and discussed the purpose of the visit.

The facility is a Residential Care Facility for the Elderly (RCFE). License capacity of (6) with a current census of (0). LPA observed no residents at the facility during the inspection. The Administrator stated that the facility has not had long term residents in care since September 8, 2023 but in January of 2025 had two residents for a short time. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following:

Physical Plant: Indoor and outdoor passageways are free of obstruction. The facility has no bodies of water accessible to residents in care. Outdoor shaded area is sufficient for resident activities. The facility has sufficient lighting and is maintained at a comfortable temperature. Bathroom showers, faucets, toilets are maintained in operating conditions. The hot water temperature in residents' bathrooms measured 106 degrees F. Resident’s bedrooms have sufficient furniture, and space for residents. LPA observed two of the resident bedrooms did not have lamps. Facility has operating carbon monoxide alarms. The facility has sufficient linen, towels, and personal hygiene items for residents. The facility has posted in a common area, Community Care Licensing complaint poster, Ombudsman poster, disaster evacuation plan and emergency telephone numbers.