Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 02:12PM. LPA met with Administrator Charmie Hayag. Licensee Maricel Villaverde was contacted via telephone and arrived at the facility at approximately 02:50PM. Entrance interview conducted.

Beginning at 02:20PM, the LPA, along with Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

COMMON AREAS : This includes the living room and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit. The LPA observed the fire extinguishers to be fully charged and last serviced on 06/30/2023. Hardwired smoke detectors and separate carbon monoxide detector were tested at 05:12PM and were functional at the time of the visit.

BEDROOMS : There are four (4) bedrooms in the facility; three (3) bedrooms are designated for shared resident use and one (1) staff room. The staff room is kept locked. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

BATHROOMS : There are two (2) bathrooms for resident use. Restrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the bathrooms. The water temperature was measured in the shared resident bathroom and measured in compliance with regulation.

KITCHEN : The LPA observed the kitchen/dining area to be clean. Kitchen appliances were in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable