Facility Evaluation Report

Licensing Program Analysts (LPAs) Tao and Hanna conducted an unannounced annual inspection visit. LPAs met Jasbindar Singh, Administrator and explained the purpose of the visit. The facility has a capacity of six (6) to serve residents from age 60 and above which may have six (6) non-ambulatory and approved for four (4) hospice waiver. Current resident census is three (2). Two (2) residents are on hospice.

During the visit, the infection control domain tool was used, a tour of the facility was conducted, food supply was reviewed, and medications were reviewed.

This home is a single story house located in a residential neighborhood in Covina . It is a single story house with a ramp and a guard rail that leads to the front entrance, The facility consisted of five (5) bedrooms, two (2) bathrooms, office, living room, dining, room, kitchen, back yard and a carport

The kitchen was clean and has maintained the required two (2) days perishable and seven (7) days non- perishable. Each resident's bedroom had a dresser, chair and closet space available. Adequate linen and personal hygiene supply were observed. Bathrooms inspected and were clean, operable, with the required grab bars and non-skid materials in the shower. Hot water temperature was in a range of 113.2 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies.