Facility Evaluation Report

Licensing Program Analyst (LPA), Mayra Cota, conducted an unannounced annual visit today. LPA met with Hugh He, Administrator, and the reason for the visit was explained.

The facility is licensed to serve (1) bedridden and (5) non-ambulatory residents age 60 and above. Bedridden approval is granted to any room with direct exit, not to exceed (1) bedridden resident. Hospice waiver is approved for (1) resident, approval for front unit only. There are currently (4) residents living in the facility.

The property has (3) separate units. Each unit has a living room, dining area, kitchen, (2) resident bedrooms, (1) bathroom and (1) staff break room. The property also has a front and backyard and a detached garage with a laundry area and storage unit.

LPA observed the following during today’s visit:

The facility was observed clean inside and out. Walkways, passageways, ramps and exits are kept clear of debris and obstructions. Furniture throughout the facility kept is clean and in good repair. The kitchens were observed clean and appliances were operating properly. The facility has a sufficient 2-day perishable and 7-day perishable supply of food in each unit. Resident bedrooms have the required furniture, bedding and sufficient lighting. Bathrooms were observed clean and sanitary and the water temperature measured within compliance range of 105 – 120 degrees F. Front and backyard are kept clean. No pools or bodies of water were observed. The laundry area is kept clean, and appliances are in operating condition. The garage was observed free of clutter.