Facility Evaluation Report

Licensing Program Analyst (LPA) Arielle Pascua conducted an unannounced required-1 year inspection visit on 08/10/2022. LPA Pascua was greeted by staff member, Reginald Sampablo who was asked to call the administrator to let them know that CCL was present at this time. Shortly after, LPA Pascua met with Facility Designated Administrator, Christine Quiruz and stated the purpose of today's visit. There were two other staff members present, Maria Serrato and Robert Quiruz. Administrator holds a current certificate and expires on 11/06/2022.

This facility is vendorized by Valley Mountain Regional Center to accept and retain Level 4I residents at this time. Census was currently at 4. Tour of the facility was conducted with Facility Designated Administrator, Christine Quiruz and House Manager, Maria Serrato.

The facility has a main entrance screening point. The facility has a 30 day supply of PPE. The facility conducts disinfecting cleaning daily.

The interior of the physical plant was in good condition and sanitary. Fire extinguishers appeared to have been annually inspected by Armor Fire Extinguisher Company 01/11/2022.

The kitchen area was toured. LPA observed a sufficient seven days of non-perishable foods as well as two days worth of perishable food supplies in the main kitchen. Additional perishable and non-perishable food supplies were identified out in the back patio.

Dining areas, living areas, and all other areas intended for resident use were toured. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time.

A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees.

A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time.

A tour of the resident bedrooms was conducted. Resident furniture was observed to be sufficient to meet the resident needs at this time. A tour of the staff bedroom was also conducted.