Facility Evaluation Report

On 08/25/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct an annual visit. LPA was greeted by staff member (SM) Ferdinand Estroba and explained the purpose of the visit. LPA was met by SM Lillibeth Sarmiento and asked that SM Sarmiento call the Facility Designated Administrator at this time to inform them that CCL was present. There were 2 other staff members present at the time of this visit, Alona Bastida and Noel Sarmiento.

This facility is licensed to serve 6 residents who are 60 and older and can be deemed non-ambulatory. This facility holds a hospice waiver for 6 and has a dementia program on file.

LPA reviewed 6 resident files. All resident files are current and up to date. LPA reviewed 4 staff files.

All staff files are current and up to date.

The Administrator has an expired certificate but has renewed their certificate prior to expiration date and is awaiting for a new certificate from the department.

Fire extinguisher located by the garage door appeared to have been annually inspected by Jorgenson Co on 05/22/2023.

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 refrigerator 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 dining room. Along with Administrator, 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.