Facility Evaluation Report

On 12/10/2025 at 9:00 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. Upon arrival, LPA met with Caregiver Apple Pedullon and explained the reason of the visit. Administrator Steve Chou arrived at 10:15AM. The facility's fire clearance was approved for six non-ambulatory of which one may be bedridden in room 5 only.

LPA toured facility with Caregiver including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of six (5) total bedrooms which all occupied by the residents. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 115.9 and 115.2 degrees F. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Sharps are locked and inaccessible to residents.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 11/11/2025. Emergency Disaster Plan last updated 11/11/2025. First aid kit was observed to be complete. Fire drill was last conducted on 11/11/2025.

LPA reviewed 3 staff records and 3 of 3 staff have current first aid training and associated to the facility. LPA reviewed 5 residents records and 5 of 5 residents have current medical assessment.