Facility Evaluation Report

On 1/30/2023 at 9:15am, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a 1-Year annual visit. LPA Pascua was greeted by staff member, Nora Baay Casaverde and was asked to call the Facility Designated Administrator at this time to let them know that CCL was present. Shortly after, LPA Pascua was able to speak to the Facility Designated Administrator and explained the purpose of the visit. At this time the LPA was notified that the FDA could not make it to the facility and allowed the staff member to sign for paperwork. There was one other staff member on site, Nelia Baay.

The administrator has an active Administrator Certificate #6018539740 and is valid until 08/14/2024.

The interior of the physical plant was in good condition and sanitary. Fire extinguisher in the facility was present.

The kitchen area was toured. LPA observed a 7-day non-perishable and 2 day perishable foods in the cabinets and refrigerator. Additional non perishable food supplies were identified in the cabinet in the hallway.

LPA observed a locked centralized stored medication cabinet located. Along with the administrator, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components.

A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. LPA observed bleach under the sink and reminded the staff that cleaning supplies need to be in a locked and made inaccessible to the residents. 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 bedrooms was conducted. Resident furniture was observed to be sufficient to meet their needs at this time.