Facility Evaluation Report

Licensing Program Analyst (LPA) Vaid conducted an unannounced annual inspection visit. LPA met with Margaret Granich, LVN and discussed the visit. Licensee Kenny Yu assisted with the facility inspection. The facility is licensed to serve six (6) non-ambulatory of which two (2) may be bedridden, ages 60 years old and above. The facility has an approved Hospice Waiver for six (6) residents. Currently, there are six (6) residents on hospice in placement. Administrator certificate is current and the expiration date is 11/30/2026.

The facility inspection consists of the following: 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 six (6) bedrooms, three (3) bathrooms, kitchen, dining room, laundry room, family room, administrator office, activities room, and living room with a TV. Passageways, walkways, entrance and patio were free from obstructions. Rooms were furnished with appropriate furniture for residents’ comfort and in compliance. The bathrooms were furnished with grab bars and nonskid surfaces. Common areas were observed for the ability to safely serve the needs of the residents. Facility maintained a comfortable temperature for residents at 76 deg F. Auditory alarm devices to monitor exits were operable. The outdoor activity area had a shaded patio with ample seating.

Hot water temperature was measured in a range of 112.4- 119.1 deg F. 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. Two (2) Fire extinguishers were fully charged and serviced on 02/11/26. Mandated documents and signages were posted in common areas. Medication was centrally stored in a locked cabinet. Resident records were stored in a locked cabinet. Liability insurance expires 10/22/2026.

No deficiencies were observed on todays’ visit. An exit interview was conducted and this report/appeal rights were provided to Licensee Kenny Yu.