Facility Evaluation Report

Licensing Program Analyst (LPA) Arielle Pascua arrived at this facility on 08/01/2022 at 10:00am to conducted an unannounced annual visit. LPA Pascua was greeted by caregiver, Marissa Baisas and stated the purpose for today's visit. Caregiver, Baisas was asked to call the Facility Designated Administrator to let them know that CCL was present at this time. There was two other staff members present, Teresita Lim and Lyn Testmio. This facility holds a hospice waiver for 2.

Census was currently 5. A tour of this facility was conducted with caregiver, Baisas.

Administrator holds current certificate and expires on, 03/09/2024.

The facility has a main entrance COVID screening point. The facility has a 30 day supply of PPE. The facility conducts disinfecting cleaning daily.

Fire extinguisher located in the laundry room appeared to have been annually inspected on 07/07/2022.

The kitchen area was toured. LPA Pascua observed a sufficient seven days of non-perishable as well as two days worth of perishable food supplies in the main kitchen. Additional perishable supplies were identified in an additional freezer located in the garage. Knives and additional cleaning supplies were locked and made inaccessible to the residents at this time.

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

Common areas were toured. Living room, dining area and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time.

Laundry area was toured. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time.

A tour of the garage was conducted. Additional storage for supplies were stored in cabinets. All additional cleaning supplies were locked and made inaccessible to the residents at this time.

A tour of the resident bedrooms was conducted. Resident furniture was observed to be sufficient to meet the resident needs at this time. A tour of the staff bedroom was also conducted.