Facility Evaluation Report

At approximately 9:45 PM, Licensing Program Analyst (LPA) Stevenson arrived unannounced to conduct a required 1-year annual inspection and was greeted by facility Staff Imelda Mallari who has Designation of Facility Responsibility (RP). RP called Administrator who arrived at approximately 9:55 AM to assist with today's inspection

Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care. Facility has a Dementia Care Plan, and a Hospice waiver for three (3) and facility currently cares for two(2) hospice residents.

Licensee recently modified home and applied for one (1) converted non-ambulatory bedrooms which the fire department granted on 08/13/2025. Facility is now approved for 6 non-ambulatory residents.

At approximately 10:15 AM, LPA initiated a tour of the facility with House Manager and observed the following: Facility is a one story home, was a comfortable temperature, bright and facility was without odors. Passageways were free from obstructions. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were observed locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Facility also has an emergency generator available.