Facility Evaluation Report

Licensing Program Analyst (LPA) Rankin arrived at 12:25 p.m. to conduct a 1-year required annual visit. LPA met with Amelita Aquino, Administrator and Thelma Tablada.

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: LPA toured resident rooms and observed that rooms were tidy, the lighting and lamps are sufficient for the use of the facility and for resident comfort and safety. Toilet, hand washing and bathing facilities are operational. The showers have non-skid mats/flooring. The pathways are clear of any obstructions. The facility has sufficient space inside and outside for activities and visiting. The facility has telephone and internet service for residents’ use. The fire extinguisher was last charged and inspected on 10/18/24. Administrator will send receipt for purchase of new fire extinguisher. The facility has carbon monoxide and smoke detectors that were tested and working.

Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of 6. The fire clearance is granted for 4 non-ambulatory and 2 ambulatory residents. Facility has a hospice waiver for 6. The facility currently has 1 ambulatory and 3 non-ambulatory. (Continued on 809-C)