Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection today. Upon arrival, a female Lolita Macabadbad (LM) opened the door for LPA. LM stated there is no resident in facility. LPA called administrator (ADM) Shirley Richards. ADM stated ADM will be at facility in 5 minutes. LPA waited at outside for 5 minutes.

ADM stated the facility is non operational. ADM stated ADM and ADM's aunt LM live in this house. LPA did not see any COVID poster at the door, or at the main entrance or in the facility. There is no screening station in the house.

LPA toured the facility inside out with ADM. Living room, family room, dinning room, kitchen were observed. Two restrooms were observed. One office, 4 bedrooms, and one master bedroom were observed. No resident or staff was observed in facility.

The house was in non operational status. LPA suggested ADM to close the facility if the facility is in non operational status.

Exit interview was conducted with ADM. This report was provided to ADM for signature.