Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Staff S1, Maribel Dadacay. During the visit, LPA observed 4 residents and 3 staff. LPA explained the purpose of the visit. Staff S1 contacted ADM via phone call. ADM stated he was unable to come to the facility due to a family members illness. ADM stated facility staff would be able to assist LPA with visit.

LPA toured the facility inside out with S1 which included the Living room, kitchen, dining room, 2 restrooms and 3 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways.

Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 70 degrees F, and hot water temperature was measured at 112 degrees F in both resident bathrooms.

Fire extinguisher was serviced in September 26, 2024. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by S1, and were functional. LPA observed facility first aid kit. LPA requested to review facility drill log. The last drill conducted was on January 7, 2025. ADM stated he could not find records for drills conducted in 2024.

LPA reviewed facility records for 3 residents. LPA requested to review resident R2's preadmission appraisal. ADM confirmed R2 moved into the facility during the covid period. Facility staff was unable to provide a copy of R2's preadmission appraisal to review. LPA reviewed 3 staff records. LPA reviewed 3 P&I records.