Facility Evaluation Report

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was allowed entry and discussed the purpose of the visit with Caregiver Justin Tagorda, Administrator Jerome Tagorda arrived shortly after. According to the facility’s license, the facility has a maximum capacity of six (6)residents. All of whom may be non-ambulatory and one (1) may be bedridden. Hospice waiver is approved for three (3) residents.

LPA toured the interior and exterior of the facility, and inspected each room. 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, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. Hot water temperature was measured in the facility at 117 degrees F. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present.

There are no bodies of water on the premises. Per Administrator, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

At this time there are no residents in care, therefore resident records were not reviewed.No deficiencies were observed or cited during today's annual inspection.

An exit interview was conducted with Administrator Jerome Tagorda whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.