Facility Evaluation Report

Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to conduct a Required – 1 Year Annual inspection. Upon arrival LPA was greeted and granted entry by Carestaff Hermelinda Palma and May Ong. LPA began inspection with introduction and visit purpose. There are currently 6 Residents residing and present at the facility. Facility currently has 1 resident receiving Hospice care. Administrator (AD) Chi "Rex" Luu arrived shortly after.

LPA along with AD Rex conducted a tour of the inside and outside of the facility. LPA observed the facility to be clean and in good repair. The home is maintained at a comfortable temperature for the Residents. Lighting is sufficient for safety and comfort. The facility is a two story, 5 bedroom, 3 bathroom home with a dining room, living room, kitchen, and attached garage on first floor. The second floor has 2 bedrooms, and 1 bath that is used by staff only. There is a back yard with a patio cover for the residents. Resident bedrooms were observed to be spacious and easily accommodate furnishings such as lamps, chair, dresser and a bed. Bathrooms were clean, faucets, showers and toilets were operational. Water temperature tested at 115.7 degrees F. Linen and hygiene supplies were stocked in 2 hallway closets. Emergency Phone Numbers and Exit Plan were reviewed. Food prep areas are clean and organized. Food supply does not meet the requirement of one (1) week supply of non-perishable and two (2) day supply of perishables. Emergency food and water supply is available. Smoke detectors are centrally wired and carbon monoxide detectors were found to be operational. LPA and AD observed the 3 Fire Extinguishers that were mounted were last serviced on 04/15/2021. Stove burners, microwave, washer, and dryer are operational. There is a locked location for chemicals and sharps in the kitchen. Laundry is done in the garage, and there is a locked cabinet for storing laundry soap and other chemicals. Medications are centrally stored in a locked metal file cabinet. Medications reviewed appear to have been dispensed accurately.