Facility Evaluation Report

At 10:15 am on this day, April 12, 2024, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA was granted entry by Mohammed Arafat, licensee, and informed the reason for visit. Doreen Khan, administrator. arrived at around 10:50 a.m.

Administrator submitted a copy of updated LIC9282 Infection Control Plan which LPA received on May 5, 2023.

LPA toured the facility inside out with the licensee. LPA inspected the kitchen, dining area, living room. bedrooms, bathrooms, garage and backyard. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked.

Facility has 2 in 1 carbon monoxide and smoke detector that was tested, and observed functional. Facility conducts fire and earthquake drills at least every quarter and records showed last conducted March 17, 2024. Fire extinguisher checked, observed fully charge and receipt showed purchased May 3, 2023. Hot water temperature in the common bathroom was tested and measured at 107.2 degrees Fahrenheit.

LPA reviewed 3 staff and 4 residents records, and interviewed 2 staff. Medications were checked and compared with doctor's order and LIC622 Centrally Stored Medication and Destruction Record. P&I were checked and compared with last recorded balance.

At 10:37 a.m., LPA observed the laundry room/office converted to resident's room