Facility Evaluation Report

On 08/06/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct an annual visit. LPA was greeted by staff member (SM) Alona Bastida and explained the purpose of the visit. LPA asked that SM Bastida call the Facility Designated Administrator at this time to inform them that CCL was present. Shortly after, LPA met with Facility Designated Administrator (FDA), Maria Angelica Souxouay. There was one other staff members present at the time of this visit, Ferdinand Estroba.

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.

Current census was 4. 1 out 4 residents were out at the hospital during the time of this visit.

LPA reviewed 3 resident files. LPA reviewed 3 staff files. 3 out 3 staff files are complete and up to date. The administrator has an active administrator certificate #6016477740 and expires on 04/29/2025.

Fire extinguisher located by the garage door appeared to have been purchased on 06/08/2024 and had an attached receipt to it.

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.

Common areas were toured. Living room, dining area and all other areas intended for resident use were in compliance and good repair.