Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required

annual visit at 01:05PM. This annual had a specific emphasis on infection control practices and procedures.

The LPA initially met with staff Eufrecina Tabuena. Licensee Maricar Lee arrived at the facility at 01:13PM and discussed the reason for the visit. Entrance interview conducted.

The LPA, along with Licensee, toured the physical plant areas inside and outside at 01:15PM to ensure there are no health and safety hazards. The following was observed:

BEDROOMS : The LPA observed the resident bedrooms, which were furnished appropriately with clean

linens, appropriate furnishings and sufficient lighting. There are 5 total bedrooms – one (1) bedroom is

shared for resident use and four (4) are private.

RESTROOMS : 3 restrooms were observed to be clean and sanitary and in operating condition. Showers were also observed to have grab bars and non-skid surfaces. The LPA observed sufficient amounts of soap and paper products in each restroom. At 01:27PM, in a common hallway restroom, water temperature measured at 125.6 degrees Fahrenheit.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good

condition. At the time of the visit, common seating area and dining room furniture was observed to be in good condition.

The LPA observed the required postings in the common hallway. Fire extinguishers were observed to be serviced within the last year. Hardwired smoke detectors and carbon monoxide were tested at 01:30PM and