Facility Evaluation Report

At 12:35pm on 02/19/2026, Licensing Program Analyst (LPA) Jeffries arrived to the facility unannounced to conduct the facility annual inspection. LPA met with Alternate Administrator, Rosemarie Luna, announced who he is and the reason for the visit. Assigned Administrator Rodolfo Pacaoan is currently out of the country.

This is a four bedroom, two bathroom, facility with two living rooms, dining room and kitchen, there is an out door area in the back and front of the facility with seating and shade for residents with visitors and activities. Three of the bedrooms are double resident occupancy and the forth bedroom is dedicated for overnight staff. LPA observed resident bedrooms to be properly furnished with proper linin and utilities in working operations. LPA observed liquid soap and paper towels in the two bathrooms that are available to all clients and staff. LPA noted that files and medication are locked in a lockable filing cabinet adjacent to secondary living room. LPA noted that there is a complete first aide kit and a working fire extinguisher between the dining room and the secondary living room. LPA observed at least two days of perishable foods and at least seven days of nonperishable foods on hand for six residents and staff. LPA tested carbon monoxide detectors and smoke detectors all to be functioning. LPA noted that all hallways, door ways, and exits were free and clear of debris. LPA conducted a file review of staff and resident files. LPA reviewed facility emergency disaster plan and infection control plan. LPA verified facility liability insurance. Alternated Administrator and LPA conducted a full review of the annual care tools module and noted no other violation than the one mentioned above. At this time there are no violation and no other issues during this annual facility inspection.

Exit interview, report read, appeal rights and report provided.