Facility Evaluation Report

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA met with administrator, Cherie Wood, and explained the reason for the visit.

At 9:03 AM, with the assistance of administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. At 9:53 AM the smoke alarms were tested and are operational that are located each bedroom, the hallway and kitchen. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen. The charge date is 5/12/2025. During the visit the facility is at 73 degrees Fahrenheit. The facility is fire cleared for 2 ambulatory and 4 non-ambulatory, of which 1 may be bedridden. Bedroom #3 and Bedroom #4 cleared for non-ambulatory or bedridden. Hospice waiver for 4.

Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a gas stove, faucet, freezer, refrigerator, and microwave. LPA observe that two (2) out of four (4) gas range was only working. Deficiency will be cited in LIC 809-D. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked cabinet in the kitchen. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away in the under the kitchen sink.

Bedrooms: There were five (5) bedrooms designated for residents' use and staff. Bedroom #1 and bedroom #4 are for private used. Bedroom #2 and bedroom #3 are shared. Bedroom that are in used by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Bedroom #5 is for staff use and was kept locked. Continue to LIC 809-C