Facility Evaluation Report

At approximately 10:00 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a Case Management - Annual Continuation inspection and was greeted by Staff. Licensee, Luningning "Nina" Sikat, was contacted and informed LPA that Staff 2 (S2), also a Designated Responsible Party (DRP) would come to the facility to conduct the inspection with LPA. DRP arrived at approximately 11:30 AM. Facility is a Residential Care Facility for the Elderly (RCFE) with four (4) residents in care. Facility has a hospice waiver for three (3) and is approved for six (6) non-ambulatory residents.

At approximately 12:00 PM, LPA and S2/DRP toured facility and observed the following: Facility is a one story home, was a comfortable temperature, and 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. Medications were centrally stored and locked. There is a shaded seating area in the backyard with outdoor space for activities. LPA observed an activity schedule, books, puzzles, and games for residents. LPA advised DRP that facility shall obtain an internet access device designated for resident use. DRP agreed to purchase one to ensure facility is operating in compliance with regulation.