Facility Evaluation Report

Licensing Program Analyst (LPA) Rankin arrived at 11:09 am to conduct a 1-year annual visit to the facility above. LPA met Administrator Juanito Pasion and explained the purpose of the visit.

A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit:

Physical Plant & Environment Safety: The facility has 5 bedrooms and 2 bathrooms, with 1 bedroom and 1 bathroom dedicated to staff. The facility is occupying 4 residents and employs 3 staff of which one is the Administrator and two are live in staff. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors, both were tested and were working at the time of visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The facility kitchen is clean, safe and sanitary. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care locked in garage cabinets. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard for client use with furniture. The backyard has a locked shed to store extra furniture and items.

Operational Requirements: The facility has a current plan of operation on file. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 01/30/2026. The facility is approved for a capacity of 4 non-ambulatory of which 2 may be bedridden.

Staffing/Personnel Records & Training: The facility employes 2 staff and 1 Administrator, back-up staff are available when needed. Staff records are kept confidential. LPA reviewed 3 staff files. Files reviewed for 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. All files Continued 809-C