Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an pre licensing inspection visit and met with Administrator (ADM) Perla Cayabyab. License, ADM certificate, and personal rights posters were observed in the facility. LPA reviewed 3 resident files and 3 staff files. LPA observed 1 staff and 2 residents in the facility.

LPA toured the facility inside and out with ADM. Family room, activity room, dining area, kitchen, 4 resident rooms, 1 staff/storage room, 2 restrooms, and laundry room were inspected.

Medication closet was observed locked. Knives closet, and dish washing soap closet were observed locked. Room temperature was at 71 degree F, and hot water temperature was at 116 degree F in facility. The temperature of the freezer is at 0 degree F and the temperature of the refrigerator is at 40 degree F. 2 days perishable food supplies and 7 days non perishable food supplies were observed sufficient.

Fire extinguisher was serviced on 1/5/2026. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Carbon monoxide detectors were tested, and were working. First aid box, night lights, and flash lights were observed in the facility. First aid box, flash lights and night nights were observed at the facility. The last time the facility conducted the fire drill was on 3/2/2026.

Front yard and backyard were inspected. There was no obstruction block the walkway to exit gates. One storage room was observed in the back yard.

No citation was noted today. Exit interview was conducted with ADM. A copy of the report was provided to ADM for signature. A copy of the report was provided to ADM.