Facility Evaluation Report

Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced visit to the facility for the purpose of an annual inspection. LPA met with Licensee/Administrator, Mylene Bumanlag, and Licensee, Jennifer Kim.

Structure: Facility is a four (4) bedroom, three (3) full bathrooms, single story house, with a detached garage. Detached garage has been converted to be used as office space. There is a kitchen, dining area, laundry room, and 2 living room areas. Front and backyard landscape are in good condition and free of obstruction or debris. Rear patio is covered and provides shading. Patio furniture, which consists of a table and (5) chairs. Signal System : No signal system in facility. Bedroom Residents: The three (3) client bedrooms each consists of (2) two twin beds with proper bedding, including mattress pads, a dresser, night stand, proper lighting in addition to a lamp, and a chair. Bedrooms contain ample closet space. Bedroom Staff: There is (1) one staff bedroom to be used by live in staff. Bathrooms: (3) full bathrooms are available for resident use. Water temperature measured between 108 F degrees - 114.6 degrees F in all water faucets tested. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, a pillowcase, a mattress pad, a fitted sheet, a blanket and a bedspread. Adequate supply of linen is stored in hallway closets. Emergency Phone Numbers, Personal Rights, Visiting Policy, Exit Plan, & Menu: Emergency Disaster Plan, Personal Rights, Visiting policy, emergency numbers, and menu are posted and readily available for review in dining room area. Facility has a land line telephone located in the living room dining area. One (1) fire extinguisher is located in the dining area and is fully charged. Activity Supplies: sufficient activity supplies were observed. Food Service: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in a locked kitchen cabinet drawer. Dishwasher in kitchen is properly installed and functioning. LPA observed a sufficient amount of perishable and non-perishable food supply on today's visit .