Facility Evaluation Report

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with staff #1 and shortly after with Administrator, Sandy Jeong, and explained the reason for the visit. At approximately 11:50 am, with the assistance of the staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. LPA tested the smoke alarms and the carbon monoxide detectors, and they were functioning properly. The fire extinguisher is located in the kitchen. The charge date is June 6, 2025.

Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility, properly stored. Knives were stored in a locked drawer in the kitchen. Bedrooms: There were four(4) bedrooms designated for residents' use. Two (2) bedrooms are designated for private use, and two (2) rooms are shared. Currently, Room#3 is vacant. All four bedrooms, in use by residents, were properly furnished with appropriate beddings and linens with sufficient lighting.

Bathrooms: The facility has four (4) bathrooms. Three (3) bathrooms are designated for residents' use, and one(1) bathroom is designated for staff. All bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 107.8 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Staff Workstation/Offices: There are staff offices located adjacent to the living room, where staff and residents' records are kept and locked in a filing cabinet. Properly labeled medications were also locked in one of the office cabinets. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. (Continue on 809C)