Facility Evaluation Report

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

Two staff and one residents were observed in the facility. The other 3 residents went to day program. One staff (S1) was found not associated with the facility. ADM stated he/she requested Human Resource Department to transfer him/her from other ELWYN facility before.

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 reviewed 2 staff files and 2 resident files.

LPA toured the facility inside out with ADM. Living room, kitchen, dinning room and two restrooms were inspected. Four resident bedrooms, laundry room, and garage were inspected. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. The temperature of the refrigerator was observed at 42 degree F, and the temperature of the freezer was observed at 0 degree F. Medication closet, knives closet, and cleaning product closet were observed locked. Room temperature was at 69 degree F, and hot water temperature was at 108 degree F.

Fire extinguisher was serviced on 02/17/2024. The facility was equipped with smoke and carbon monoxide detectors. ADM tested carbon monoxide detectors 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 to block the walkways. One storage room was observed at the backyard.

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