Facility Evaluation Report

Licensing Program Analyst (LPA) Vaid conducted an unannounced annual inspection visit. LPA met with caregiver Kristina Brown whom assisted with the facility tour and the Licensee Kenny Yu was informed and arrived shortly after. LVNs Carrion and Grancich also arrived to assist with staff and resident files. The facility is licensed to serve four (4) non ambulatory, of which two (2) may be bedridden in Room#1, ages 60 years old and above. The facility has approved Hospice Waiver for four (4) residents. Currently, there are two (2) residents in hospice placement Administrator certificate is current and the expiration date is 07/22/2026.

During the visit, LPA completed the Care tool, interviewed staff/residents, reviewed staff/residents' records, toured the facility, reviewed food supply and medications. The facility is a single-family residence located in a neighborhood, consisting of two (2) bedrooms, one (1) bathroom, kitchen, dining area, laundry area, and sitting area; combined. Passageways, walkways, entrance and patio are free from obstructions. Rooms are furnished with appropriate furniture for residents’ comfort and in compliance. The bathrooms are furnished with grab bars and nonskid surfaces. Common areas are observed for the ability to safely serve the needs of the residents. Facility maintained a comfortable temperature for residents. Auditory alarm devices to monitor exits were operable. The outdoor activity area had a shaded patio with ample seating. Facility liability expires10/22/2026.

Hot water temperature was measured in a range of 105.9 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies were observed. Sufficient supply of perishable and nonperishable foods was observed. Knives, tools, and sharp items were inaccessible to residents. Smoke and carbon monoxide detectors were dual/hardwired and operable. Fire extinguishers were fully charged. Medication was centrally stored in a locked cabinet in the living room and inaccessible to residents. Resident records are stored in a locked cabinet and inaccessible to residents.