Facility Evaluation Report

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at approximately 9:00 A.M. When the LPA arrived, there was three (2) staff members and three (3) residents present. The LPA was greeted by Caregiver, Jonie Nay Del Rosario. LPA informed the reason for the visit. Caregiver contacted the Administrator by phone, Amelita Gagarin. At 9:20 A.M., Administrator and back up Administrator Jovelito Gagarin, arrived at the facility. At 10:14 A.M. Administrator received a phone call and had to exit annual visit. Back-up administrator is authorized to sign today’s report.

Beginning at 9:43 A.M., the LPA, along with Administrator and back-up Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit.

KITCHEN : Kitchen appliances appeared to be in operable condition. At 9:45 A.M. hot water measured at 111.8 degrees. Cleaning supplies were stored in a locked cabinet under the kitchen sink. The facility has a sufficient supply of perishable and non-perishable food. At 9:57 A.M., LPA conducted a review of expiration dates on product labels. The LPA observed that three (3) items were past their expiration date. Back-up Administrator discarded all three (3) items during today’s visit. Technical Advice Issued.