Facility Evaluation Report

On 8/21/2025, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct a required Annual Inspection. Upon arrival LPA was greeted by the Caregiver/Staff Lapingao Raul, who granted access to the facility. LPA introduced herself by showing her badge and explained the reason for the visit. The facility Administrator Liem Inge contacted over the phone. LPA Khurshudyan reviewed the required postings on a wall throughout the facility. The inspection tool was used to complete today's visit.

At 10:55am LPA, with the help of Caregiver, began a physical plant tour of the facility and the following was observed: This is a single-story building with five (5) bedrooms, two (2) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for four (4) ambulatory clients. Facility is operating level 2 clients.

Kitchen: LPA observed a seven-day supply of non-perishable food, and a two-day supply of perishable food properly stored and labeled. No expired food was observed. Facility stores knives and sharps inside the locked storage closet located by the entrance door. Emergency supply of food / water was stored inside the pantry. Food storage and preparation areas are clean and inaccessible to pests. LPA observed one (1) fire extinguisher located throughout the house. The fire extinguisher was last serviced on 3/19/2025. A weekly menu was also available for clients.

Bedrooms: There are five (5) bedrooms in the facility, of which four (4) are designated for clients use and one (1) bedroom for staff use. All bedrooms are for private use. LPA observed bedrooms to be properly furnished with beds, linens, night stands, chairs, drawers, closets, and adequate lighting. All bedrooms appeared organized and clean.