Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter arrived announced to conduct the facility's pre-licensing visit. LPA met with Administrator (ADM) Erwin Dumantay. LPA observed 2 residents and two staff during visit. The other 3 residents were attending day program during LPA's visit.

During visit, LPA toured the facility inside and out. The tour of the facility included the living room, 5 resident bedrooms, 3 bathrooms, garage, kitchen/dining room, and backyard.

While touring the backyard, LPA observed bedroom #2 does not have a sliding door screen. LPA also observed the screen for bedroom #6 is damaged and has 3 pieces of tape covering up holes. While touring the backyard, near bedroom #3's door, LPA observed an unsecured storage shed. LPA observed the shed did not have a lock and inside the shed was cans of paint and tools. ADM stated he could not find the lock but would address the issue.

While touring resident bedroom #4, LPA observed a large blue, stars and moon sticker on the bottom of the glass sliding closet door, directly across from bathroom #2. LPA observed at the edges of the sticker, the glass was split. LPA asked ADM to remove the sticker. LPA observed there glass was cracked. (Photographs were taken.) While touring bathroom #1 LPA observed the grab bar directly above the toilet did was not secure and screws were not fully secured. (Photographs were taken.) While touring resident bedroom #1, LPA observed a section next to the bed that is not painted.

Facility was observed to be clean. Fire exit routes were clear and free of obstructions. Carbon monoxide detectors was tested and observed to be functioning properly. Fire extinguisher was purchased in October 16, 2023. Bathroom hot water temperature was measured to range from 107-109 degrees F. Facility temperature observed to be 72 degrees F. First Aid Kit observed to be complete. No open bodies of water noted at facility. Page 1 Out of 2.