Facility Evaluation Report

At approximately 9:20 AM, Licensing Program Analyst (LPA) Robert arrived unannounced to conduct a 1-Year Required Visit and was greeted by Staff Member, Laurel Roque. Licensee/Administrator, Luingning “Bot” Alicdan, arrived during the visit at approximately 9:50 AM. Facility serves older adults and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance and total capacity for 13 residents of which 11 residents can be non-ambulatory, and 2 residents can be bedridden. Facility has an approved hospice waiver for 3 individuals. Facility has approval to have a locked perimeter. Upon arrival, LPA was informed that there were twelve (12) Residents in care and 3 staff members on-site. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation.

At approximately 9:50 AM, LPA toured the facility with Administrator Alicdan. All exits were clear and unobstructed. Facility fire extinguishers were last serviced and tagged in May, 2024. Fire extinguisher servicing and inspection is scheduled for 6/27/2025. The automatic sprinkler system was serviced in 5/2025. The facility was sufficiently lighted. LPA inspected eight (8) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. LPA observed that six (6) various dressings and sauces that were required to be refrigerated after opening, were left unrefrigerated in a kitchen cabinet. This deficiency will be cited. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills quarterly. The last disaster drill was conducted on 5/19/2025. Continued on 809-C...