Facility Evaluation Report

Licensing Program Analyst (LPA) Vaid conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met with Administrator Tokie Ayabe and explained reason for visit.

This facility is a Residential Care for Elderly and is licensed to serve six (6) non-ambulatory elderly residents, ages 60 and above in rooms A, C, and D. One (1) bedridden is approved in room B. Hospice waiver approved for five (5) residents. Annual licensing fees are current. The facility consists of a two-story building. First floor had five (5) resident rooms, living room, kitchen, dining area and four (4) resident bathrooms. Second floor consisted of four (4) staff rooms and two (2) staff bathrooms.

All resident bedrooms were toured. Each bedroom has a bed, linen, dresser, and lighting. Smoke detectors/carbon monoxide detectors were observed in each room and throughout facility. The facility has one (1) fire extinguisher that is fully charged in kitchen, 07/24/2025. LPA observed cleaning supplies and toxic substances locked in hallway closet. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Sufficient supply of 2 days perishable & 7 days non-perishable foods were observed in the kitchen. The resident bathrooms have the required grabs bars and non-skid mats. The hot water temperature in the bathrooms was measured between the required range of 105-120 degrees F. The common areas include the living room and dining area, are clean and have the required furniture. The facility does not have a swimming pool or large body of water. There are no firearms or weapons stored at the facility. There is a shaded seating area for the residents in back yard. Passageways and exits are free of obstruction. There is a shaded seating area in backyard.