Facility Evaluation Report

On 03/28/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived at this facility unannounced to conduct an annual visit. LPA Pascua was greeted by Facility Designated Representative (FDR), Stephanie Imbat and explained the purpose of the visit. LPA Pascua aksed that FDR Imbat call the Facility Designated Administrator (FDA), Rose Imbat to inform her that CCL was present at this time. It was learned at this time that FDA Imbat was unable to come to the facility at this time and could continue the visit with FDR Imbat.

Current census was 6. A brief interview with FDA Imbat was conducted.

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 Lloyd Pagtakhan.

LPA reviewed 3 resident files and 3 staff files. Both staff and resident files were current and up to date.

Current census was 6. A tour of the facility was initiated with FDR Imbat.

The interior of the physical plant was in good condition and sanitary. Fire extinguishers appeared to have been purchased on 07/24/2023.

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.