Facility Evaluation Report

At approximately 12:15 PM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to continue a required 1-year annual inspection and was greeted by caregiver Alexander Olayvar

Facility is a Residential Care Facility for the Elderly (RCFE) licensed for 6 residents with five (5) residents in care. Facility has a Hospice waiver for two (2), with 2 hospice residents currently in care, and is approved for all non-ambulatory residents.

At approximately 12:40 PM Administrator/Licensee -Claribelle Bailon arrived.

At approximately 12:45 PM, LPA reviewed Client and Staff Files. All files were all found to be well organized, thorough and contained the required documentation. Facility does not do P&I monies for clients.

At approximately 1:45PM LPA and Licensee Bailon conducted a spot check of medication and medication records with records observed to be accurately kept. Medications were observed to be centrally stored and locked.

Licensee/Administrator to submit updates of the following documents by 05/04/2025

LIC 308 Designation of Facility responsibility (was obtained during today's inspection)