Facility Evaluation Report

On 05/24/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual

Inspection. LPA introduced self, stated the purpose of the visit, and requested to meet with staff Teresita Delatorre, Mario “Danny” Ramos, Assistant arrived shortly. All seven residents were present during the inspection.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway

obstructions or fire hazards were observed inside. All residents’ and staffs’ files reviewed. Fire extinguisher observed with purchased date 10/12/23. Medications were checked and observed kept locked in kitchen cabinet. Resident’s MARS was reviewed.

Small live roaches were observed on the kitchen counter and on the toilet in bathroom 1. Assistant stated pest control have been schedule to come out on 05/24/24 at 2:00PM. Records of the pest control service will be submitted to LPA.

An adequate supply of perishable and non-perishable food was observed. All residents’ bedrooms were toured. LPA observed single occupant in bedroom 1, single occupant in bedroom 2, single occupant in bedroom 3, single occupant in bedroom 4, and 3 resident’s bed in shared bedroom 5. LPA observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are observed with securely fastened grab bars. Hot water temperature was tested range 115.3 and 116.2 degrees F. in bathroom and range 114 and 113.8 degrees F in shared bedroom bathroom. Toilet was observed functioning and operational. Cleaning chemicals observed locked in the laundry room.

Outside of facility toured and observed free of debris with adequate outdoor seatings. Side gate was observed self-closing and self-latching. Carbon monoxide and smoke detectors were tested and observed to be operational.