Facility Evaluation Report

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to continue a Required Annual Inspection which began on 11-21-2024. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Thea Capili. LPA then met with Co-Administrator May Paraiso, who arrived shortly after.

According to the facility’s license, the facility has a maximum capacity of six (6) residents, of whom all may be ambulatory or non-ambulatory, but none may be bedridden. According to care records, staff interviews, and LPA observation: During this annual inspection, there were a total of six (6) residents in care [Resident #1 (R1), Resident #2 (R2), Resident #3 (R3), Resident #4 (R4), Resident #5 (R5), and Resident #6 (R6)], of whom all were non-ambulatory, per their respective doctors. [See LIC811 Confidential Names list pages for a description of select person identifiers used in this report.] The facility’s license did not include endorsements for delayed-egress doors or secured perimeter, and neither of these were present.

During this inspection, LPA interviewed multiple residents and multiple staff. LPA reviewed the care records for all residents and the personnel and training files for all staff. LPA also toured the interior and exterior of the facility, and inspected all common areas and bedrooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were working. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities.