Facility Evaluation Report

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Carlito Caoili.

The facility is licensed for a maximum capacity of 6 residents, 4 ambulatory and 2 non-ambulatory in bedroom #4. As of 10/8/2024, the facility has a pending fire clearance request to increase the facility's capacity to 6 non-ambulatory residents. The facility has a waiver for 6 hospice residents. During today’s visit, the facility had a census of 6 non-ambulatory residents, 5 of which were receiving hospice services. The Administrator for the facility is Laurice Gamab and their certificate was valid and current.

During today’s visit, LPA toured the facility and inspected each room of the facility, including resident and staff rooms, bathrooms for resident and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed on the premises. LPA did not observe any aspects of delayed egress or secured perimeter. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was initially measured at 130.6 degrees Fahrenheit in a private resident bathroom. LPA observed Caregiver Caoili turn down the hot water heater during the visit. LPA remeasured the hot water before the end of the visit and the hot water was measured at 118.8 degrees F in the private resident bathroom, 118.2 degrees F in the common bathroom, and 113.5 degrees F in the kitchen sink. The facility’s internal temperature was measured at 76 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. According to Caregiver Sylvia Linga, no firearms or weapons are stored on the premises.