Facility Evaluation Report

Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced One (1) Year Required annual inspection. LPA met with administrator Tami Akahoshi and explained the purpose of the visit.

A tour of the physical plant was conducted at 1:15 PM and the following were noted:

The main door is the only entrance being utilized for entry. The facility has seven (7) bedrooms and four (4) bathrooms currently occupying five (5) residents in five (5) private bedrooms. One (1) bedroom and one (1) bathroom is designated for staff use. The facility is fire cleared for six (6) non-ambulatory residents and has hospice waiver for two (2).

Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted:

Living and dining room furniture were also checked. The living room is neat and clean along with the dining room. The facility maintains a comfortable temperature at 76°F. The smoke detectors are hardwired and inter connected and observed to be operational. The fire extinguisher was filled and last checked on 03/24. There is carbon monoxide detector installed at the facility.

The front porch of the facility has outdoor furniture, with a covered shaded area for residents. The front and backyard passageways were clear of any obstruction. There is no body of water in the facility.