Facility Evaluation Report

Unannounced annual visit made out to this facility on 11/22/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregiver, Sheram Amparo, who was requested by this LPA to go ahead and contact the facility designated Administrator Joyce Mabunga to inform her that CCL was present at this time to conduct the annual visit. The facility designated Administrator Joyce Mabunga arrived shortly thereafter and was briefly interviewed at this time.

It was learned that there was a resident under the care of hospice at this time.

This facility does have a hospice waiver for (4) residents at this time.

Administrator certificate was observed to be present and in compliance at this time for facility designated Administrator Joyce Mabunga. Additional forms and documents were reviewed to make sure that the renewal process was initiated prior to the certificate expiration date of 07/24/2024 with certificate # 6056435740.

Kitchen area was toured. Cabinets and drawers were reviewed.

Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. This LPA did observe an additional food storage unit which was present and functional at this time in the garage area.

A tour of the dining area, living area, and all other areas intended for resident use was conducted.

Medication cabinet, located in the hallway closet, was reviewed. Policies and procedures involving dispensing, documenting, and overall administration of resident medications was discussed with the facility designated Administrator at this time. This medication cabinet was observed to be locked and made inaccessible to the residents at this time.

A tour of the resident bedrooms and restrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time.

Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees.