Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with Bruce Chow , Licensee who assisted with visit. The facility has a capacity of six (6) residents. It is licensed to serve elderly residents age 60 and above, approved for six (6) non-ambulatory, of which one (1) may be bedridden. Facility approved for three (3) hospice waivers. Annual fee is current. Administrator certificate is current and the expiration date is 10/26/2023.

During the visit, the infection control domain tool was used, a tour of the facility was conducted and food supply was reviewed. Since no resident was residing at the facility, medications were not reviewed.

The facility is located in a residential neighborhood. A physical tour was conducted. It is a single-story home consisted of three (3) bedrooms, two (2) bathrooms, living room, office area, family room/lounge, kitchen, with an attached garage.

Residents’ rooms were well furnished and in compliance. Bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. Hot water temperature was in a range of 115.5 degrees Fahrenheit which was within Title 22 Regulation guidelines.