Facility Evaluation Report

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit and was greeted by Administrator Caroline Tan and explained the reason for the visit.

The purpose of the visit is to complete the required inspection.

LPA Trueman toured the facility along with Administrator Caroline Tan today 07/07/2023 at 9:15 AM and the following was observed

Facility contains 42 Bedrooms, dining room, kitchen, TV room, and activity room.

LPA inspected Rooms which included 1st Floor #3, 4, 9, 10, 21, 22, and on the 2nd Floor 43, 44,59, 60, 61, and 62.

Hot water temperature measured between 105 F. and 120 F. meeting Title 22 Regulations.

Required Annual Inspection included Infection Control Practices, Operational Requirements, Physical Plant/ Environmental Safety, Staffing, Personnel Records/ Staff Training, Resident Records/ Incident Reports, Resident Rights/ Information, Food Service, Health Related Services, Incidental Medical Services, and Disaster Preparedness.

LPA observed sufficient supply of 2 day perishables and 7 day non perishables.

Visitation signage was posted along with signage for hand washing and proper sanitizing.

Staff responsible for providing care and supervision received training in First Aid.

Licensee maintained an individual admission agreement for each client.

Each client has personal rights free from corporal or unusual punishment, infliction of pain, humiliation, ridicule, coercion, threats, mental abuse, or other actions of a punitive nature.

Program site was clean, safe, sanitary, and in good repair at all times for the safety and well being of clients, employees and visitors.

Medication was reviewed for 8 Client's. 8 Client Files and 13 Staff Files were reviewed.

Interviews were conducted with 5 Client's and 2 Staff.

No deficiencies. Exit interview conducted.