Facility Evaluation Report

At 8:20am on 04/22/2025, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct the annual facility inspection. LPA met with Administrator, Guillerma Pacaoan, announced who he is and the reason for the visit.

Administrator and LPA conducted a full tour of the facility inside and outside. LPA noted that this is a 3 bedroom and two bathroom facility, One bedroom is designated for dual resident occupancy and the other two rooms are for single resident occupancy. there is a garage, laundry room, living room, kitchen and dining room. There is a covered porch that wraps around the back and side of the facility that provides seating and shade for residents and visitors. LPA noted that each room is furnished per licensing regulations. Both bathrooms have paper towels and liquid soap. Water tested in both bathrooms and kitchen, all to be within licensing regulations temperature (105*-120* (f)). LPA noted that there is a fire extinguisher in the kitchen that is primed and in the green. LPA tested all smoke detectors and carbon monoxide detectors to be working and were tested during facility annual inspection. LPA noted that the medications and files are locked in the living room area in locked cabinets. LPA noted that there is a complete first aide kit. LPA noted that the door ways and passage ways in the facility were free and clear of obstacles and debris. LPA reviewed all staff and resident files all to be completed and training up to date. LPA reviewed Infection control plan, emergency disaster plans and emergency drill logs. LPA conducted a review of Centrally Stored Medication Records (CSMR) and found no errors. LPA conducted a full review of the annual care tool modules. During this annual facility inspection LPA found no violations and no citations.

Exit interview, report read, and report provided.