Facility Evaluation Report

On 02/10/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA met with Facility Designated Administrator (FDA), Estrellita Banci and explained the purpose of the visit. The purpose of this visit was to conduct an annual visit.

Current census was 4. A brief interview was conducted with FDA Banci.

This facility is licensed to serve and retain 6 non-ambulatory elderly residents. 1 of 6 residents may be bedridden and could only reside in bedroom #1. This facility also holds a dementia plan on file and has a hospice waiver for 2 residents.

There are currently 2 residents on hospice services, 1 resident with assistance on oxygen and 0 are on home health services at this time.

A review of the facility records were conducted. LPA Pascua conducted a review of 4 resident files and 3 staff files. 3 out 3 staff files were complete and up to date. Based on LPA Pascua's record review of 4 resident files. 4 out 4 resident files did not have a current Needs and Services plan on file. All other components were complete and up to date. LPA Pascua provided Technical Assistance to FDA Banci regarding some best practices for resident files. FDA Banci holds an active and current administrator certificate #6029266740 and expires on 06/24/2026.

Fire extinguisher located by the living area appeared to have been purchased on 02/10/2026 with a receipt attached and is in compliance. Smoke detectors and carbon monoxide was present and in good repair.

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. Knives and additional cleaning supplies were locked and made inaccessible to the residents at this time.