Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Fay Cacdac.

LPA observed 3 staff and 1 resident in the facility. 3 residents went to day program. Two staff (S1, S2) were found not associated with the facility. ADM stated he/she requested Human Resource Department to transfer them from other ELWYN facilities before. LPA reviewed 2 resident files and 2 staff files.

License, personal rights posts were observed in the facility. ADM certificate was observed expired on 10/26/2024. Administrator provided the document for the renewal of ADM certificate.

LPA toured the facility inside and out with ADM. Living room, office, kitchen, dining room, and 2 restrooms were inspected. There are 4 resident single rooms in facility. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. The temperature of the refrigerator was 42 degree F. The temperature of the freezer was observed at 0 degree F. Knives closet, medication closet, and cleaning product closet were observed locked. Room temperature was at 68 degree F, and hot water was at 106 degree F.

Fire extinguisher was serviced on 08/20/2024. The facility was equipped with smoke and carbon monoxide detectors. Smoke detector was tested and it was working fine. First aid box was observed in the facility. Emergency light system and flash lights were observed in the facility. ADM showed the dimmer light system in the facility hallway. Front yard and backyard were inspected. There was no obstruction observed to block the walkways.

Deficiencies were noted today. See LIC809-D. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of this report was provided to ADM