Facility Evaluation Report

On 5/30/2025, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility for a required annual inspection. LPA met with Administrative Executive Director, Reu Baggao who was informed of the purpose of the visit. The facility has a fire clearance for 198 non-ambulatory elderly residents, of which 86 may be bedridden.

LPA toured the facility’s interior and exterior with Baggao. During the tour, LPA observed the facility is made up of three (3) buildings, which are designated for independent living, assisted living, and memory care. Indoor and outdoor passageways are free of obstruction. Outdoor shaded seating is available and there are several activities available for resident leisure. The facility has an in-ground pool that is gated and secured with a master lock. During tour of the kitchen, LPA observed the facility met Departmental requirements for a two-day supply of perishable foods and seven-day non-perishable food items, and sharps are secured and inaccessible to residents in care. Medications are secured in medication carts, only accessible to authorized personnel such as medication technicians. Cleaning solutions and disinfectants are secured in storage closets, inaccessible to the residents. LPA toured a sample of the resident bedrooms and private restrooms in the memory care unit, which appeared to be clean and sanitary with no foul odors. LPA also observed the facility installed protective covers to all of the memory care unit fire alarm pull stations. Baggao lifted one of the covers and showed LPA the warning horn that was placed as a preventative measure to help staff detect and possibly prevent false fire alarms. Baggao also showed LPA the new siren alarm installed on the courtyard gate to alert staff when the gate has been unexpectedly opened. LPA observed several fire extinguishers mounted throughout the facility that were last serviced on 4/21/2025 along with fire alarm systems and carbon monoxide detectors. During today's visit, no deficiencies were cited and LPA did not observe any health or safety concerns identified on 10/20/2023's non-compliance conference. An exit interview was conducted and a copy of this report was reviewed and provided to AED Baggao.