Facility Evaluation Report

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA met with staff designee and was explained the reason for the visit.

At 1:30 PM, with the assistance of designee, LPA took a tour of the physical plant. Required postings were observed in the entry area. At 1:47 PM 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 1.12.2026. During the visit the facility is at 73 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents; 6 may be bedridden and is cleared for 6 hospice waiver.

Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. 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 kitchen.

Bedrooms: There were eight (8) bedrooms designated for residents' use. Bedroom #1, bedroom #2, bedroom #3, bedroom #4, bedroom #5, and, bedroom #6 are for private used by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Bedroom #7 and bedroom #8 is for staff used and is located in the second floor. Continue to LIC 809-C