Facility Evaluation Report

Licensing Program Analyst (LPA) Karina Canela arrived for the purpose of conducting a Required -1 Year inspection and met with Virginia Punzalan, back-up administrator . Patricia Bucal, Facility Manager, and Ermelynn Goco , Live-in DSP, were also present .

LPA toured the facility, all exits were unobstructed. The facility was found to be clean & at a comfortable temperature. LPA observed a supply of linens and cleaning solutions (observed locked & inaccessible). Hand soap and paper towels are available in bathrooms. Facility food supply was within regulation and accessible to clients. Medication was centrally stored. Water temperature was tested and observed between 105 to 120 degrees F.

Fire extinguisher was charged and serviced 05/02/2023. Smoke detectors & carbon monoxide detector observed operational. LPA reviewed staff and clients records. Staff have current training certifications in First Aid & Cardiopulmonary Resuscitation (CPR) in file.

LPA requested the following updated forms to be submitted to Community Care Licensing by 08/11/2023:

· LIC 308 Designation of Facility Responsibility (1 person per form)

· LIC 400 Affidavit Regarding Client/Resident Cash Resources (indicate if not handling cash for residents)

· LIC 9020 Facility Register of Client/Residents

· Copy of current Administrator's Certificate

Exit interview conducted with co-administrator, whose signature on this document confirms receipt. ***No deficiencies cited during this inspection