Facility Evaluation Report

Licensing Program Analyst (LPA) Shobhana Frank made an unannounced visit to the facility today to conduct

required 1 year inspection. During today’s visit, LPA met with Licensee Cristina Ong and explain the

purpose of today's visit. LPA Frank toured the facility, inspected resident rooms and bathrooms, reviewed staff training records. LPA Frank reviewed centrally stored medications and records, reviewed food

services, and inspected the kitchen. In addition, LPA Frank tested the hot water temperature, which measured 112 degrees F in resident bathroom. Resident areas were noted to be a comfortable temperature.

Smoke detectors and carbon monoxide detectors were tested and found to be operational. The facility also

has fire extinguisher that was mounted and charged. LPA Frank confirmed food supply: 2 day supply of

perishables and 7 day supply of non-perishable food is available for the number of residents present.

Hygiene supplies and supply of linen were observed in quantities for the number of residents in care. LPA

observed locked areas for toxins and hazardous items. Medication were observed locked in cabinet.

LPA observed COVID - visitation station equipped with hand sanitizer, thermometer, Gloves, visitors log,

COVID posters throughout the facility. Every two week the facility conduct COVID testing for residents and staff.

LPA observe the facility to be clean and in good repair. Physical Plant and Safety of Environment/Operational as CCL

LPA Frank reviewed : 1.) Designation of Administrative Responsibility (LIC308) 2.) Personnel Report

(LIC500); 3.) Emergency Disaster Plan (LIC610E); 4.) LIC 9020A Client Roster; LIC 808) Mitigation Plan;

Based on the observations made during today’s visit, no deficiencies are being cited in area inspected.

This report was discussed with the facility representative and a copy was provided.