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 Rina Canonizado. LPA spoke with House Manager Lauren DeLancey via telephone during the visit.

The facility is licensed for a maximum capacity of 6 residents, 2 of which may be non-ambulatory in bedroom #1. The facility has a waiver for 6 hospice residents. During today’s visit, the facility had a census of 5 residents, all of which were non-ambulatory and receiving hospice services. The Administrator for the facility is Rafael 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 rooms, bathrooms for resident and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed on the premises. Upon attempting to enter the facility, LPA observed a locked gate with a keypad preventing access to the front door. Staff Canonizado exited the facility and entered a code into the keypad which unlocked the gate and allowed LPA entrance into the facility. The facility's approved fire clearance granted on 3/15/2024 did not note any use of locked perimeter or delayed egress. LPA tested the gate during the facility tour and observed that the gate was locked from both sides, preventing unobstructed egress in case of emergency. Additionally, a tour of the facility's backyard revealed that the side gate was locked at the time of the inspection and had a doorknob with a locking mechanism, further preventing egress is case of emergency. The facility was found to be clean, safe, and in good repair. The facility’s water temperature was measured at 107.2 degrees Fahrenheit at the kitchen sink and 117.0 degrees Fahrenheit in a common bathroom. The facility’s internal temperature was measured at 73 degrees Fahrenheit.