Facility Evaluation Report

Licensing Program Analysts (LPAs) Daniel Konishi and Christine Wong, conducted a required annual inspection using the Inspection Tool. LPAs met with the Manager, Tiffany Sasada and the purpose of the visit was discussed.

Infection Control: The facility has a Infection Control Plan in place. Personal Protective Equipment (PPEs) were observed. The facility continues to practice hand washing and disinfecting.

Operational Requirement: Hospice Waiver for 1 is approved. A fire clearance is in place. Liability Insurance in the amount of at least ($1,000,000.00) per occurrence and ($3,000,000.00) in total annual aggregate is in place and expires 07/11/2024.

Structure/Physical Plant: The facility is part of a single-story home located in a residential area and contains the following: living room, dining room, kitchen with refrigerator, oven, stove, dishwasher, sink/faucet, locked storage kitchen cabinet for sharps, (3) resident rooms, (2) bathrooms for residents; bathrooms with shower, toilet and washbasin. A back yard with shaded area and seating for resident use. There’s a laundry area; with washer and dryer. The residence is equipped with central air conditioning. There is an inaccessible fireplace. Adequate accommodations observed throughout facility. Hallways f ree and clean of obstruction and debris. All bedrooms are equipped with: overhead lighting, chair, night stand, lamp in addition to overhead lighting, large drawer, and closet space. All bathrooms have a working toilet, wash basin, shower, grab bars and nonskid mats. Smoke and Carbon Monoxide Detectors Electrical & connected. Battery operated & working, all detectors tested and operational. Toxins are locked/stored for staff use only. Hot Water temperature measured between 109.5 -113 degrees which is within Title 22 Regulation.