Facility Evaluation Report

At 7:30am on 06/19/2025, Licensing Program Analyst (LPA) Jeffries arrived unannounced to conduct this facility annual inspection. LPA met with Administrators Amilio & Marilou Ubay, announced who he is and the reason for the visit.

Administrators and LPA conducted a physical tour of the facility. This facility is a 5 bedroom, 3 bathroom, 1 living room, kitchen with large island and a dining room. There is a fenced back yard with table, chairs and umbrella for shade for clients, visitors, staff to use for outdoor activities and visitations. LPA observed residents rooms to have proper linins and furniture per regulation standards, LPA observed bathrooms to have liquid soap and paper towels. LPA checked facility water temperature to be within regulation standards of 105*-120*(f). LPA noted that each room has a hardwire smoke detector and the carbon monoxide detector is located above the refrigerator in the kitchen. LPA noted that the medications are locked in a cabinet in the kitchen area and there is a completed 1st Aide kit per regulations also in the medication cabinet. LPA observed two fire extinguishers both primed and in the green reading. LPA observed at least two days of perishable foods and at least seven days of non perishable foods on hand for at least six residents and staff. LPA noted that emergency water in more than sufficient quantities located in the facility garage. LPA noted that the facility was clean and in good repair and all hallways, and exits were free from obstructions.

LPA reviewed documentation of Emergency Disaster Plan, Infection Control Plan, Liability Insurance, Staff and Client files, Centrally Stored Medication Record (CSMR) all to be complete, upto date and in regulations compliance. Administrators and LPA conducted full review of annual care tools. LPA noted that there were no violations or citations as a result of this annual facility inspection.

EXIT INTERVIEW, REPORT READ, AND REPORT PROVIDED.