Facility Evaluation Report

Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required visit on this date starting at 11:30am. LPA met with House Manager, Racquel P Chou and explained the purpose of the visit. The facility's fire clearance was approved for six non-ambulatory.

LPA toured facility with Caregiver including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. 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. LPA 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 105.9 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. Centrally stored medication 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 reviewed 1/28/2026. First aid kit was observed to be complete. Fire drill was last conducted on 12/11/2025.

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