Facility Evaluation Report

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced annual required inspection and met with designated administrator (DADM) Catherine Valle and stated the purpose of the visit. Administrator Jowell Valdez was not available at the time of the visit due to prior commitment and corporate secretary/licensee Felina Roque arrived at the facility at 11:54 a.m.

The facility is licensed to serve adults 60 and over; up to 12 may be non-ambulatory. 7 maybe bedridden in bedrooms, 2,3,4,7 8 and 9, and a hospice waiver for 5. LPA observed residents and staff present. Facility has a capacity for 12 and current census is 8. 2 out of 8 residents were at the dining room having breakfast when LPA arrived. 5 out of 8 were in their room, having breakfast, watching TV and 1 out 8 was asleep. 3 staff were present assisting residents.

LPA toured the facility, including common areas, resident rooms, kitchen, bathrooms, driveway, and outdoor spaces and storage areas. Indoor temperature was within regulation of 65°F. The kitchen was sanitary and organized; knives and chemicals were locked. Food supply met requirements (2 days perishable, 7 days non-perishable). Kitchen water temperature measured at 113.3°F. Bathroom water temperature ranged from 116.6°F to 118.7°F. Refrigerator & freezer temperature is within regulation range of 40°F and freezer is at 0°F.