Facility Evaluation Report

On 05/06/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct an annual visit. LPA was greeted by staff member, Dodie Aguilucho and explained the purpose of the visit. LPA asked for SM Aguilucho to contact the Facility Designated Administrator (FDA) to inform them that CCL was present at this time. There was one other staff member present, Mater Panaligan. Shortly after, LPA met with FDA Tabitha Antonio and explained the purpose of this visit.

Current Census was 6. A brief interview with FDA Antonio was conducted.

This facility is licensed to serve 6 elderly residents of which all may be non-ambulatory. This facility also holds a dementia plan on file.

LPA reviewed 6 resident files and 4 staff files. All files were current and up to date. The administrator has an expired administrator certificate however the LPA was able to verify that the administrator was able to send in the required documents prior to their expiration. The administrator is currently awaiting the department for a renewed certificate.

The interior of the physical plant was in good condition and sanitary. Fire extinguishers appeared to have been annually inspected by Jorgenson Co on 01/19/2024. Smoke Detector and carbon monoxide was observed to be in good repair.

The kitchen area was toured. LPA observed a 7 day non-perishable and 2 perishable foods in the cabinets and refrigerator. Additional perishable food supplies were identified in the garage.

LPA observed a locked centralized stored medication cabinet located in the kitchen. Along with the administrator, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components.

A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time.

A tour of the bedrooms was conducted. Resident furniture was observed to be sufficient to meet their needs at this time.