Facility Evaluation Report

On 10/16/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct an annual visit. LPA was greeted by staff member (SM), Shamima Ali and explained the purpose of the visit. LPA asked that SM Ali call the Facility Designated Administrator (FDA), Maybelyn Ugale, and inform her that CCL was present at this time. Shortly after, LPA met with FDA Ugale and explained the purpose of the visit. There were two other staff members present at the facility, Cathleen Maghinay and Esterlita Chua.

This facility is licensed to serve 6 residents who are 60 or older. 6 out 6 residents may be non-ambulatory. This facility also holds a Dementia Plan on file and has a hospice waiver for 2.

Upon arrival at the facility, it was found that S1 was not currently associated to the facility.

LPA asked to review staff and resident files. LPA was informed that staff did not know where files were, however, the facility administrator would be able to find the files when she arrives at the facility. LPA informed the facility that files shall be readily available upon request. LPA reviewed 3 resident files. 3 out of 3 resident files were observed not to have a current Appraisal form and did not have a Pre-Appraisal. 1 out 3 resident files did not have a current physicians report on file. LPA reviewed 3 staff files. 3 out 3 staff files were observed to be incomplete. Upon reviewing facility files, LPA observed FDA Ugale take several sharps from an open drawer and place them into a locked cabinet.

The current administrator does not have a current active administrator certificate, however, the administrator has provided the department the proper renewal forms prior to their expiration date on 09/17/2023. The department reviewed a payment on 09/08/2023.

A tour of the kitchen was conducted. LPA observed a sufficient amount of 2 day perishable and 7 day non-perishable food supply at this time. Knives were locked and made inaccessible in a separate closet away from the kitchen at this time.