Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by Licensee(LE)/Administrator (AD), Sopheap Thong and explained the reason for the visit. Facility is licensed for 6 ambulatory clients. Currently there are six clients.

LPA Tea reviewed six client files and two staff files. There were discrepancies noted in the review of resident and staff files.

LPA Tea and AD Thong toured the facility at around 9:45 AM. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of 3 shared client bedrooms, 1 caregiver room, 3 bathrooms, living room, dining room, family room and kitchen and attached garage. LPA observed smoke detectors/carbon monoxide in client bedrooms and they are operational. There are cameras with no audio recording in the common area for security purposes. Client bedrooms had the required furniture, and closet/drawer space to accommodate each resident comfortably. Mold was observed in one bedroom ceiling. Linen closet needed more linens, sheets and comforters to meet client needs. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured at 119.4 F degrees. Client bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Doorways were free of obstructions. First aid kit had all the required elements including bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA Tea observed sharps and toxins not stored securely in the kitchen area. AD Thong secured toxins and sharps securely and made them inaccessible to clients after LPA Tea's observation. One stove burner was not working properly. The fire extinguisher in the dining room was fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating in the backyard. LPA observed emergency food and water supply in the garage.

Continuation of annual inspection on LIC809-C