Facility Evaluation Report

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Caregiver Marilou Delapena. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, one (1) of which may be bedridden. Bedridden may reside in bedrooms 1, 4, or 5. The facility is approved for four (4) hospice waivers. During today’s inspection there were five (5) residents in care. Licensee Ferdinand Agpaoa arrived later during the visit.

LPA accompanied by Caregiver Delapena and Licensee Agpaoa, toured the interior and exterior of the facility and inspected each room. Licensee The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant: one common bathroom sink was 107.7F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment (PPE). LPA observed staff to utilize PPE and perform hand hygiene when assisting residents.

The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. Knives were locked and inaccessible to residents in care.