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. 11/3/2027) was off site at the time of visit. There are 4 clients, who were all attending Day Programs at the time. 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 and a comfortable temperature of 72 F. Water temperature measured 106.5 degrees F. All client bedrooms had required furnishings and decorated by each client to show off their personalities and preferences. Bathrooms were clean and sanitary and had soap and paper towels, non-skid mats for showers and baths. All staff have current first aid/cpr certifications on file. Fire extinguisher was charged and serviced 12/08/2025. Carbon monoxide detector and smoke detectors were operational. Last fire drill was on 12/08/2025 for the NOC shift. The facility has an ample supply of perishable and non-perishable foods as required by Title 22.

LPA reviewed all four client and four (4) staff files and found them to be organized and complete.

There were no deficiencies found at the time of inspection. No citations issued.