Facility Evaluation Report

On 02/27/2023 at 9:30am, Licensing Program Analyst (LPA) Arielle Pascua arrived at this facility unannounced to conduct an annual visit. LPA Pascua was greeted by Facility Designated Administrator, Rose Imbat and explained the purpose of the visit. The purpose of this visit is to conduct an annual visit. The Facility Designated Administrator currently holds an active certificate #6025575735 and expires on 03/30/2023. This facility is licensed to hold 6 residents who are deemed to be ambulatory only. This facility is also vendorized by Valley Mountain Regional Center to hold Level 2 residents at this time. There were two other staff members present, Joel Encinta and Stephanie Imbat.

Current census was 5. A tour of the facility was initiated with FDA Imbat.

The interior of the physical plant was in good condition and sanitary. Fire extinguishers appeared to have been purchased on 05/11/2022. The facility has a centralized screening point at the front of the facility and holds a 30-day supply of PPE.

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 in the garage. Knives were observed to be locked in a kitchen cabinet and made inaccessible to the residents at this time.

LPA observed a locked centralized stored medication cabinet located in the kitchen. Along with a staff member, 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. 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.

Common areas were toured. Living room, dining area and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time.