Facility Evaluation Report

On 08/06/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA Pascua was greeted by Staff Member(SM), Teresita Lim and explained the purpose of the visit. LPA asked that SM Lim called the Facility Designated Administrator( FDA) to inform them that CCL was present at this time. LPA was informed that the FDA was unable to come at this time and was to continue the visit with Facility Designated Representative (FDR), Aldrin Basarte. There was one other staff member present, Lorna Capaypangan.

This facility is licensed to serve 6 residents, of which all may be non-ambulatory and 1 may be bedridden. This facility also has a hospice waiver for 4 and has a dementia program on file.

LPA reviewed 4 resident files. 4 out 4 resident files did not have an initial or current needs and services plan. 1 out 4 resident files did not have an updated physicians report. LPA reviewed 4 staff files. 4 out 4 staff files were current and up to date.

A tour of the facility was conducted with FDR Basarte.

Fire extinguisher located in the laundry room appeared to have been annually inspected and is valid until 07/07/2025.

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 the Facility Designated Representative, the LPA observed, reviewed, and compared resident medication with the medication dispensing logs. It was observed that the medication administered for today was not accounted and signed for. This was remedied during this visit. First Aid Kit was present and contained all of the required components.