Facility Evaluation Report

Licensing Program Analyst (LPA) Amy Goldenberg conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to the Central Applications Unit (CAU) on 03/08/2022 for a total capacity of 6 non-ambulatory residents. Fire Clearance was granted 12/21/2021 This facility is a change of ownership. There are 4 residents currently in care. LPA met with applicant Rowena Formeloza. LPA Goldenberg observed the following:

Structure: Facility was a single story house with four (4) resident bedrooms, two bathrooms, living room, dining area, and kitchen area.

Heating/Cooling System: Central heating and air conditioning systems. Facility is maintained at a comfortable temperature.

Bathrooms: Bathrooms have a working toilet, wash basin, and shower with an adequate supply of towels, toilet paper, and toiletries. Water temperature measured by applicant and thermometer read by LPA at 105 F.

Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots and pans were observed. Cleaning supplies and knives/sharp instruments were secured in a locked cabinet and drawer. There was adequate room for food storage. Refrigerator/freezer were in working condition and had sufficient storage for perishable food. There was adequate seating for meals.