Facility Evaluation Report

On August 7, 2025, at 2:00 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Caregiver Emma Tablang. A phone call was made to Assistant Administrator (ASAD) Catherine Hsi who explained Administrator Thi Nhu Mai Do was not available because they will be away from the facility from August 4, 2025, to August 20, 2025. ASAD Hsi stated they could not attend today’s visit and CG Tablang could sign on behalf of the facility.

The facility is licensed to operate for five (5) non-ambulatory residents, of which one may be bedridden and have a hospice waiver for six (6) residents. The facility is a two-story building located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, two bedrooms on the second floor, four (4) bathrooms, living room, common area, dining area, office area, kitchen, attached 2-car garage, and an outside covered patio area.

LPA Kim toured indoor and outdoor of the physical plant with CG Tablang. There are no obstructions or bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be clean and operational. Bathroom water temperature measured between 132.0 degrees F and 132.9 degrees F. A comfortable temperature of 78 degrees F was maintained in the facility.