Facility Evaluation Report

Licensing Program Analyst (LPA) Rankin arrived at 11:05 a.m. to conduct a one-year annual visit to the facility above. LPA met with Administrator Rodolfo Pacaoan and explained the purpose of the visit.

A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit:

Physical Plant & Environment Safety: The facility has 3 resident bedrooms, 1 caregiver bedroom and 2 bathrooms. Facility currently occupies 3 residents. LPA was authorized to enter and inspect facility. The facility has a smoke and carbon monoxide detector that was tested and working properly during visit. Fire extinguishers were last reviewed in May of 2024 and are fully charged. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid mats. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care locked in a room in the garage. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use and front patio has plenty of shade. The facility has telephone and internet service for resident use.

Operational Requirements: The facility has a current plan of operation on file with the department. The facility has current liability insurance and expires on November 3, 2025. The facility is approved for a capacity of 6. The fire clearance is granted for 6 non-Ambulatory of which one may be bedridden. Hospice is approved for 3.