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 caregiver staff and explained the reason for the visit. Licensee (LE) Ban Nguyen is currently out of the country, but LPA was able to communicate with him via text message. LE Nguyen would stand by for assistance if needed. The facility is licensed for six non-ambulatory residents with a hospice waiver for five. Currently there are six residents, of which none are on hospice during today's visit.

LPA Tea reviewed six resident files and two staff files. There were discrepancies with resident files. Some resident files are missing forms and need updated physician’s reports. The facility is up to date with required quarterly emergency disaster drills, which were last conducted in February 11, 2026. The administrator certificate expires October 17, 2026.

LPA Tea along with staff toured the facility. LPA toured the physical plant, checked the food service, and the first aid kit. The facility is a two-story home, the first floor consists of five resident bedrooms, two bathrooms, a living room, family den, dining area, kitchen and attached garage. The second floor is a private resident area; no care residents reside on the second floor. Private residents are background cleared. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, and showers were free of mold/mildew. The water temperature measured between 116.9 to 118.9 Fahrenheit degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of