Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to T3 Adult Residential Care. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the home and explained the reason for the visit. Facility is licensed for 4 ambulatory clients and the facility currently has 4 clients. Max Nguyen has an Administrator Certificate expiring on 01/17/2026. Administrator Tien Luu arrived during the visit. Upon entry into the facility, LPA observed pre-poured medications unsecured in dining area.

LPA Lyman along with Administrator Tien Luu toured the facility at 9:43 AM. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of four client bedrooms, one shared hall bathroom, client restroom, staff restroom, living room, dining room, and kitchen. Client bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. At 10:00 AM, LPA observed unsecured vitamins in Client 1's (C1) room. Client bathrooms were checked. Toilets and water faucets worked properly, and shower was free of mold/mildew. Water temperature measured between 114 and 114.9 degrees F in facility bathrooms. Client bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors. LPA observed a locked storage area for cleaning supplies in the laundry room. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and Carbon Monoxide detectors tested operational during today's visit. Fire extinguisher is fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample shaded seating for clients. Exit gates are unlocked and operational. LPA observed ample emergency food and water supply. LPA reviewed the emergency disaster plan as well as infection control plan during the visit. Plans are thorough and complete. Facility provided documentation of last fire drill conducted on 12/28/2023. Facility provides activities in the form of movies and outings in the community. At 10:20 AM, LPA reviewed four client files and three staff files. Client files contained required documents including admission agreements, physician reports and client appraisals. CONTINUED ON LIC 9099C DATED 03/20/2024