Facility Evaluation Report

On 8/25/2025, Licensing Program Analyst (LPA) Janette Romero made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Licensee, Rolando Corpuz who was informed of the purpose of the visit. The facility has a fire clearance to serve six (6) non-ambulatory elderly residents of which one (1) may be bedridden. The facility also has an approved hospice waiver for six (6) and LPA was informed all five (5) residents are currently receiving hospice services at the facility.

LPA toured the facility with licensee and observed the facility is made up of a one-story home with five (5) resident bedrooms, three (3) bathrooms, a kitchen, two (2) dining areas, living room, laundry room, and detached garage. Resident bedrooms had the required bedding, furniture, and lighting. Bathrooms had grab bars and non-skid mats in the showers. The facility has an in-ground pool that is secured with a locked gate. Indoor and outdoor pathways were free of obstruction. The facility had more than a two-day supply of perishable foods and seven-day supply of non-perishable foods. Knives and medications are secured in separate locked kitchen cabinets. Licensee tested one (1) of the smoke alarms/carbon monoxide detectors and LPA heard it to be operational. LPA also observed charged fire extinguishers mounted in the facility that were last serviced on 1/3/2025. The facility's certificate of liability insurance expires on 8/6/2026. Staff present have a criminal record clearance and are associated with the facility. Resident files reviewed had the required Departmental records. LPA reviewed the facility's Fire and Emergency Disaster Drill Report Form noting the facility's last fire drill was conducted on 4/15/2025. Long Term Care Ombudsman's contact information, residents' personal rights, complaint procedures, emergency disaster plan, and facility sketch are visibly posted on the hallway wall leading to the residents' bedrooms. During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided to Licensee Corpuz.