Facility Evaluation Report

On 10/07/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unanounced to this facility to conduct an annual visit. LPA was greeted by Facility Staff Member (SM), Romulado Gusto and explained the purpose of the visit. LPA Pascua asked SM Gusto to call the Facility Designated Administrator (FDA), Margaret Feril to inform them that CCL was present at this time. It was learned that FDA Feril would arrive within the next hour and could continue the visit until she arrives.

This facility is licensed to serve 6 residents who are 60 and older. 1 out 6 residents may be non-ambulatory residing in the bedroom with a direct exit. 5 out 6 residents shall only be ambulatory.

This facility also holds a dementia plan on file and a holds a hospice waiver for 3.

Current census was 3. 1 out 3 residents were out at a medical appointment at this time. It was learned that there is currently one resident on hospice services at this time.

A brief interview with SM Gusto was conducted.

LPA conducted a record review of 3 resident files and 3 staff files. 3 out 3 resident files did not have a pre-admission assessment on file. 2 out 3 residents were identified as non-ambulatory based on physicians reports conducted. Administrator has a current administrator certificate #7020961740 and expires on 12/05/2025.

A review of the facility medication and medication administrator records were conducted. LPA observed, reviewed, and compared medication to medication dispensing logs. First Aid Kit was present and contained all of the required components.

Fire Extinguisher was in compliance and has been services by Resilient Fire Protection on 07/20/2025.

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.