Facility Evaluation Report

Licensing Program Analyst (LPA) Jill Nakagawa arrived at the Adult Residential Facility (ARF) unannounced to conduct Required- 1 Year visit and met with Joannalyn Agbayani , designated responsible party. Administrator, Eveyln Samson (Adm. Certificate #7001249735 Exp. 11/3/2025) was off site at the time of visit. There was one staff member and no clients at the initial time of inspection. There are 4 clients, who were all attending Day Programs. This facility is a single-story home with 6 bedrooms: 2 bedrooms for staff and 4 bedrooms for residents.

LPA toured the facility, all exits were unobstructed, and the facility was found to be clean & at a comfortable temperature of 69 F. Renovations had just been completed to the living room and kitchen areas. And the facility was freshly painted and new floors installed. Water temperature measured 106 degrees F. Bathrooms had soap and paper towels, non-skid mats for showers and baths. All staff have current first aid certifications in file. Fire extinguisher was charged and serviced 12/16/2024. Carbon monoxide detector and smoke detectors were operational. Last fire drill was on 01/21/2025 for all shifts. The facility has an ample supply of perishable and non-perishable foods as required by Title 22.

LPA requested the following updated forms to be submitted to Community Care Licensing by 02/10/2025:

Copy of current Lease/Rental Agreement expires 09/01/2025

There were no deficiencies found at the time of inspection. NO CITATIONS ISSUED.

Exit interview conducted with Joannalyn Agbayani, whose signature on this document confirms receipt.