Facility Evaluation Report

Licensing Program Analyst (LPA) conducted an unannounced case management - other visit and met with Administrator (ADM) PHILOMENA AGBONTAEN.

LPA observed 4 residents in the facility and 3 residents went to day program.

LPA toured the facility inside and out with ADM. 5 resident rooms, 1 staff live-in room, 2 restrooms, living room, family room, kitchen and garage were inspected.

LPA interviewed 4 residents )R1, R2, R3, R4). 4 out of 4 residents stated they like to live in the facility. 4 out of 4 residents stated the facility does not have change recently, and the facility operates as usual. 4 out of 4 residents stated they do not have any complaint.

LPA interviewed ADM. ADM stated the facility operates normally as before. ADM stated he/she is waiting for the underwriter to document to the bank. ADM stated he/she will conform with LPA for the formal purchase closure date of the house.

LPA toured the backyard, 1 storage room was observed at the backyard. No obstruction was observed to block the walkway.

Exit interview was conducted with ADM. The report was provided to ADM for signature. A copy of the report was provided to ADM.