Facility Evaluation Report

On 04/17/25, Licensing Program Analyst (LPA) M. Yang conducted a Pre-licensing and Component III inspection for Change of Ownership. Upon arrival LPA delay egress door. LPA introduced self, stated the purpose of the visit, and was granted entry into the facility. LPA met with Licensee Elsa Nguyen, Administrator Maria Ceballos, and Administrator Assistant Christina Gomez. All 26 residents were present during inspection.

Fire clearance was granted for 44 non-Ambulatory for total of 44 capacity. Delayed egress doors observed.

A sample of resident files were reviewed to have Admission Agreements, Physician Reports, and Pre-Appraisal. A sample of staff files were reviewed to have a criminal record clearance, fingerprinted clearance, and good health screening. Chemicals observed stored and locked in locked housekeeping closet. Facility dryer observed operating during inspection. Fire extinguisher observed throughout the facility with serviced date 03/11/25 and 03/06/25. LPA observed an extra supply of bed linens and personal hygiene products. All resident bedrooms were observed to have required furnishings and lighting.

All bathrooms were toured. Bathrooms are observed with securely fastened grab bars and non-skid mat. Hot waters were tested at 118 degrees F in bathroom 1, 123 degrees F in bathroom 2, 85.3 degrees F in bathroom 3, 88.3 degrees F in bathroom 4, and 71.7 degrees F in bathroom 5. Courtyard was observed free of debris and adequate outdoor seatings observed available for residents.Medications observed locked in medication cart in the medication room. First aid kit was observed and contained all required items. Carbon monoxide and smoke detector tested operational during visit. LPA observed a 2-day supply of perishable foods and a 7 day supply of non-perishable foods. Temperatures maintain at 38 degrees F in refrigerator 1 and -11 degrees F in freezer. First Aid kit observed with gauze, bandages, a roller, and trauma pad.