Facility Evaluation Report

At approximately 9:50 AM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct annual continuation inspection and was greeted by Elsa Magaoay, Administrator. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care, three of whom are currently receiving Hospice care. LPA requested all resident files and medications for review.

At approximately, 10:30 AM, LPA conducted file review of all six (6) resident files and observed the following: six (6) of six (6) resident files reviewed contained all the required documents per Title 22 regulations. LPA observed the three (3) Hospice residents' Hospice care plans. Five (5) employee files were observed to have all required paperwork including evidence of 20 hour of annual education, 1st aid/CPR, TB clearance and criminal record clearance.

At approximately 11:30 AM, LPA reviewed medications and medication records which are maintained and stored in compliance with regulation.

No deficiencies cited during today's inspection.

Exit interview conducted with Administrator whose signature on form confirms receipt of documents.