Facility Evaluation Report

On 06/10/24, 9:45AM Licensing Program Analyst (LPA) Raymond Comer conducted an unannounced Annual visit at the Facility. LPA met with caregiver who contacted the Facility Administrator, Doris Duong, and reason for the visit was stated.

Facility is licensed as a single-story residence for four (4) ambulatory, of which, none may be bedridden. Facility has four (4) private resident bedrooms, and two (2) bedroom space designated for Staff. Total of three (3) bathrooms.

At 10:00AM , LPA conducted a tour of the physical plant with the Administrator and observed the following:

Resident records: Resident files were reviewed for current IPP and/or Needs and Services plans, physician report, and admission agreements. Resident records appeared to be complete and current.

Staff records: Staff files were reviewed. Criminal record clearances, Health Screening, Employee Rights Records were present and Staff are associated to this facility. Staff records appear to be complete and current.

Physical plant : At 12:05pm, LPA inspected facility for cleanliness and condition . Facility’s main door is the primary entry/exit access. Screening area is located immediately upon entrance. Visitor Sign-in sheet, hand sanitizer, gloves and masks are available. Covid 19 prevention protocols are posted. Hand washing, coughing etiquette, and other necessary signage are posted in the bathroom and throughout the facility. Room temperature is comfortable; wall thermostat displays a setting of 116.1°F . within the required range.