Facility Evaluation Report

On November 18, 2021, Licensing Program Analyst (LPA) Komal Charitra and Jaime Vado conducted an announced pre-licensing inspection visit in relation to an initial application. LPAs met with Administrator, Chris and Marie Cayabyab explained the purpose of today's visit. This facility is an all ambulatory facility with 2 shared bedrooms and 1 bathroom.

LPAs toured the facility and grounds with the administrators. No accessible bodies of water or fire safety hazards observed, LPA observed the centralized communal living room area. LPAs observed that the fire screen still needs to be installed. According to the Administrators the fire screen and the bedroom dressers will be put together on 11/22/2021.

LPAs observed the bathroom. The bathroom is equipped with hand-washing signs, liquid soap, paper towels, and non-skid mats. Water temperature in bathroom is measured at 120F. LPA advised Administrator to cover trash can with a lid. Bedroom 1 was observed to have two beds, 6FT apart. Dressers to be installed. Bedroom 2, beds will be rearranged to where the beds will be 6ft apart. Night stands and night lights are present in both rooms. Dressers will be installed and placed in the rooms Monday. Extra linen and first aid kit was observed to be present.

LPAs observed the carbon monoxide and fire alarms present. Emergency night lights were present in the hallway. Kitchen area was toured and there were two locked cabinets for sharps and medication. Laundry room was observed in a locked basement area for staff only. Washer and dryer are observed as functioning.

LPAs advised to post COVID-19 signage throughout the facility. LTCO posting needs to be posted..

Report was reviewed with the Administrators and the a copy will be provided.