Facility Evaluation Report

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year Visit and met with Fay Cacdac, Administrator.

During visit, LPA toured the facility inside and out. LPA toured the kitchen area. LPA observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the first aid kit and found it to be complete.

LPA observed the resident bathroom. The bathroom had available soap and a shower chair. LPA observed the sink water temperature to be 111 F.

LPA toured four out of four resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as working lights.

LPA toured the outside of the facility and observed the outdoor exit to be clear of obstructions.

LPA reviewed four out of four resident records and four staff records and found them to be complete.

See LIC809-D page for more information. Page 1 of 2.