Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced Annual/Required visit to this facility today. LPA met with Administrator Susan Park and explain the reason for the visit.

The facility has a fire clearance for 98 non-ambulatory residents,15 of which may be bedridden. Hospice Waiver for ten (10) residents. No one is receiving Hospice Care at this time. The facility is also fire cleared for delayed egress. The facility had submitted and approved Mitigation and Infection plan.

The facility is a single storey building located in a residential neighborhood consisting of 81 rooms. There is one (1) large activity room/living room, room designated for arts and crafts, large and small dining room, beauty salon, medication room and a basement parking and two (2) laundry room located in the mid section of the building.

At 9:12 AM, LPA conducted physical plant tour of the facility with the Administrator. Facility currently has 32 residents on the Assisted Living Waiver (ALW) program. Common areas, including the living room, activity room and dining room appeared to be clean and properly furnished. The kitchen was clean and the appliances and fixtures are functional. Refrigerated and frozen foods were stored at proper temperatures and properly packed and stored. There was a sufficient amount of perishable and non-perishable food at the facility. Residents do not have access to the kitchen; dangerous items are stored and inaccessible to residents. The facility menu appears to meet the daily dietary needs of the residents. There were no pesticides or poisons observed near any food areas. Entry/exits passages were free of obstruction. The outdoor area was clean and free of hazards. The patios and balconies have proper furnishings.