Facility Evaluation Report

On today's date Licensing Program Analyst (LPA) William Vanegas conducted an unannounced visit for the purposes of conducting an annual inspection. Upon arrival LPA was greeted and granted entry to the facility by facility staff. LPA explained the purpose of the visit and Administrator (AD) Augustine Au was notified via telephone. AD arrived shortly after to assist LPA with the annual inspection. LPA began a tour of the facility and observed the following. AD Augustine Au has a valid Administrator certificate valid from July 30,2024 through July 29, 2026.

The facility is a one storried home equipped with six bedrooms all which are utilized by clients in care, additionally the facility is equipped with two bathrooms, and an attached two car garage. LPA observed the PUB475 sign along with all required postings posted on the wall along the entrance of the facility. LPA observed kitchen area to be clean and free of any mildew and debris. LPA observed kitchen area to be equipped with a gas stove, refrigerator, and a microwave. All appeared to be in good repair and tested operational. LPA observed the facility to be equipped with a two day supply of perishable food and a seven day supply of non-perishable food. Additionally the facility has a sufficient amount of emergency water on hand.

LPA observed all client bedrooms to be large enough to walk about freely, and to be free of any hazards and debris. LPA observed all resident rooms to have all required furnishings such as a bed, clean linens in good repair; meaning no strains or tears, a chair, a lamp, a chest of drawers, and enough storage space to store personal belongings. LPA observed all restrooms to be clean and free any mildew and debris. LPA observed water faucets and toilets to be operational. LPA observed restrooms to have all required furnishings including a shower chair, grab bars, and slip resistant floor matts. Hot water temperature tested between 115.7 and 117.5. Continued on LIC809-C