Facility Evaluation Report

On this date, October 16, 2024, Licensing Program Analysts (LPAs) K. Nguyen and P. Manalo conducted an unannounced pre-licensing inspection, and met with Coelestis Chan, applicant administrator. Administrator application is for 6 (six) total capacity, 6 non-ambulatory (all).

LPA toured the facility with the applicant. Physical plant is consistent with the facility sketches submitted to Centralized Application Bureau (CAB). There is no body of water. Bedrooms were observed appropriately furnished with adequate lighting. Supplies of towels, bed sheets, linens were adequate. Equipment and supplies for residents' personal hygiene were available and on site. Food supplies were observed adequate for seven days of non-perishables. Facility is equipped with refrigerator, microwave, dishwasher, washer and dryer. Storage where knives and medications is centrally stored was observed.

Fire extinguisher checked, observed fully charge with tag showed serviced April 22, 2024. First aid kit checked and observed complete with manual. Hot water temperature was tested in one of the common bathrooms and measured at 106 degrees Fahrenheit. Carbon monoxide and smoke detectors were tested and observed operational.