Facility Evaluation Report

On 01/08/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conducted to an annual visit. LPA Pascua was greeted by Staff Member (SM), Cecilia Catbagan and explained the purpose of the visit. The purpose of the visit was for an annual visit. LPA Pascua was notified by Facility Designated Administrator (FDA), Cecil De Lara that she is currently not available to come to the facility and has Designated, Mary Jane Del Mundo as the Facility Designated Representative to continue the visit with LPA Pascua. There was one other staff member present, Marysan Murphy.

This facility intends to hold 8 non-ambulatory residents. This facility also will hold a dementia plan on file and a hospice waiver for 6 residents.

Current census was 6. A brief interview with FDR Del Mundo was conducted.

The perspective Facility Designated Administrator (FDA), Cecil De Lara has a current RCFE Administrator certificate #7030906740.

LPA Pascua reviewed 6 resident files and 4 staff files.

A fire extinguisher was identified in the kitchen area and was serviced by Jorgenson Co and is valid until 01/02/2026. Smoke Detectors and carbon monoxide were observed throughout the facility and was observed to be in working condition.

A tour of the kitchen area was conducted. Toxins, cleaning supplies, and knives were observed to be locked and made inaccessible. LPA observed a sufficient amount of 2 day perishable and 7 day non-perishable food supplies at this time.

A tour of the living area was conducted. Furniture and furnishing were observed to be in good repair and could meet resident needs.

A tour of the backyard was conducted. Gate and perimeter fence was in stable condition. This facility has one exit gate in which was self closing and self latching. Two sheds were identified.