Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced case management visit and met with designed Administrator Steve Comtiag (DADM).

The purpose of today's visit is to physically inspect the facility after the completion of the facility fire clearance inspection with the fire department.

LPA toured the facility inside out with DADM. Living room, kitchen, family room, dining room, 6 resident rooms, 2 resident restrooms, a staff room with a bathroom inside, and a medication room and office with a restroom that converted from a garage were observed. 3 storage rooms were observed locked in the back yard.

LPA interviewed Administrator (ADM) Divina Fernadez (ADM) on the phone. ADM stated fire department inspector toured the facility inside out including the back yard. ADM stated he/she showed the inspector the staff room, the medication room, office with the restroom in garage. ADM stated he/she showed the backyard to the inspector. ADM stated at end of the fire clearance inspection, the inspector told him/her the fire clearance inspection passed.

ADM agreed that it is fine to have another fire clearance inspection for the medication room and office with restroom in the garage.

DADM provided a fire clearance inspection form with the result of passed.

Exit interview was conducted with DADM. The report was provided to DADM for review and signature. A copy of the report was provided to DADM.