Facility Evaluation Report

Licensing Program Analyst (LPA) Rankin arrived at 11:47 am and made an unannounced 1-year required annual visit to the facility above. LPA met with Anna Teresa Tolentino, administrator, and explained the purpose of the visit.

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: The fire extinguisher was last charged and inspected on 1/2025. The facility has 5 bedrooms and 2 bathrooms currently occupying 6 residents. The facility has smoke and carbon monoxide detectors that were tested. The lighting is sufficient for the use of the facility and for resident comfort. The toilet, hand washing and bathing facilities are operational and secure grab bars are present. The showers have non-skid mats and or flooring. The pathways are clear of any obstructions. Disinfectants and cleaning solutions are inaccessible to residents in care. The facility has sufficient space inside and outside for activities and visiting.

Operational Requirements: The facility has current liability insurance that expires on 1/30/26. The facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of 6. Fire clearance is granted for 6 bedridden residents. A hospice waiver is approved for 2 residents.

Staffing Records and Training: The facility currently employs 5 full-time caregivers, 1 reliever and 1 administrator, if needed more staff can be pulled from other facilities nearby. Files reviewed had required documentation including but not limited to 1st Aid/CPR, Health screening with TB results, Criminal Record statements, and Fingerprint clearance. Administrator’s Certificate expires 1/16/27. Staff have annual training completed for various subjects/topics and hours for 2024 and 2025. Continued 809-C