Facility Evaluation Report

Licensing Program Analyst (LPA) Arlene Garcia conducted an unannounced Annual/ Infection Control visit on this date. LPA was greeted by caregiver, Andres Villaluz. (C1). LPA met with MAYBELYN MAGSAYO-UGALE, Administrator (AD). Administrator Certificate valid until 9/17/2021.

LPA and C1 inspected physical plant including but not limited to the main kitchen, residents bedrooms and bathrooms, laundry room, and dining room area. LPA observed sufficient seven days non-perishable and two days perishable food supplies in the main kitchen. LPA observed sharps and centrally stored medications locked in pantry closet.

Hot water temperature was measured in residents' bathroom with C1 at 120 degrees which is in required range of 105 to 120 degrees. LPA observed there was a Carbon Monoxide/ Fire monitors in facility. Fire extinguisher maintained on 6/23/21.

LPA reviewed 3 staff and 5 resident files. Resident files were incomplete. LPA observed missing preappraisals, incomplete emergency contact.

All persons in facility fully vaccinated with exception to 1 staff due to personal reasons. LPA observed staff wearing masks. LPA observed 30 days PPE supply in laundry room.