Facility Evaluation Report

Licensing Program Analyst (LPA) Simi Rai arrived announced to conduct the facility's pre-licensing visit. LPA met with Applicant, Madonna Dumantay. This location has an operating facility and LPA Rai observed 3 residents and 6 staff present at the facility.

The facility is one story home. The facility has an approved fire clearance for 2 non ambulatory residents and 4 ambulatory residents.

LPA toured the facility inside and outside including the apartments, bathrooms, kitchen, dinning room and common areas. Resident rooms were equipped with proper furniture and lighting. Facility temperature maintained at 70 degrees Fahrenheit. Bathrooms are equipped with grab bars, nonskid floors, hygiene supplies, and toiletry. The facility has designated medication rooms with locked medication cabinets. LPA observed first aid kit with the following supplies: bandages, scissors, tweezers, and thermometer. LPA Rai observed supplies of 2 days of perishable and 7 days of non-perishable supplies.

During today's visit, LPA Rai observed a shed unit being occupied as a habitual space in the backyard which was not on the LIC 999 Facility Sketch. LPA Rai observed room with bed mattress and personal items along with a functional bathroom which included a toilet, sink and shower. Applicant flushed the toilet and the water passed through and the water tank filled up. LPA Rai turned on the faucet and water poured into the sink without restriction. Applicant stated the unit was built around December 2022/January 2023 as a studio. LPA Rai observed an electric power plug extending from inside the unit and connecting with a power plug coming outside the resident's window of the facility building.