Facility Evaluation Report

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of conducting the Required 1-Year annual evaluation using the Care Inspection Tool. LPA was greeted and granted entry by Caregiver Jesus Benbinen and explained the reason for the visit. Administrator (Admin) Clara Han arrived on premise to assist with the inspection approximately 9am. Administrator Han has a valid administrator's certificate expiring on February 10, 2027.

The facility is a single story structure and is licensed to operate for six non-ambulatory and has a hospice waiver for four residents. LPA observed two caregivers providing care to six residents. During the tour of the physical plant, LPA observed six resident bedrooms and two resident bathrooms. There is a private staff bedroom occupied by two staff and one private staff bathroom. Resident bedrooms had all required furnishings. Bathrooms were found to be in compliance, clean, and operational except the private bathroom of Bedroom #3 evidenced by an unclean sink and shower. The private bathroom is not in use which was confirmed by Resident #5 (R5). The hot water temperature measured at 112.2 and 111.7 degrees Fahrenheit. All common areas were inspected including the attached two car garage which doubled up as an office and laundry area. LPA observed sufficient emergency food and water. Emergency supplies were unavailable. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food available in the kitchen. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. LPA observed sufficient seating and shading. The outdoor shed was secured and inaccessible. The outdoor fountain did not have water. The fire extinguisher was mounted, charged, and serviced on April 4, 2025. The auditory devices and smoke/carbon monoxide detectors were tested and operational in all areas.