Facility Evaluation Report

On 12/09/2025 at 11:17 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to conduct 1-Year Annual Required inspection. At 12:00 pm, Kirsta Belle Alatas, Administrator arrived and and met with LPA. LPA explained the purpose of the visit.

LPA toured facility 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 71 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 114.4 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents.

Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 10/03/2025. Emergency Disaster Plan was last posted on 08/01/2025. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 12/09/2025.

LPA reviewed 5 residents records and 5 staff records; all were complete. LPA also reviewed a sample of resident’s medications. The following documents were reviewed during the visit: LIC 308 Designation of Administrative Responsibility, LIC 309 Administrative Organization , LIC 500 Personnel Report, LIC 610E Emergency Disaster Plan, Liability Insurance, Current Administrator’s Certificate

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.