Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection. LPA met with administrator, Jung Chun and explained the reason for the visit. The facility is licensed for 4 adults, ages 18 through 59, of which 2 may be non-ambulatory. Rooms #2 and #3 are approved for non-ambulatory. There is currently no client residing at the home as the licensee expressed the intent to convert the facility into a Residential Care Facility for the Elderly.

The facility is a one story house consisting of 4 bedrooms, 2 bathrooms, living room, office space, dining area with kitchen, and a detached garage. The laundry area is located outside in the backyard. The spacious back yard is well maintained and has a shaded area. There are no pool or bodies of water on the premises. Each bedroom has the required furniture, lighting, and closet space. Knives and cleaning products are locked in the kitchen cabinets. There are operable smoke detectors and a carbon monoxide detector. The water was not tested today due to city turning off the water temporarily. The food supply is adequate. There is a centrally stored medication cabinet located in the kitchen area. No medications or files were reviewed since there are no clients. Staff and Client files will be stored at the facility.

No deficiencies were issued. LPA provided reminders of expectations for operation.

An exit interview was conducted and a copy of the report was given to the administrator.