Facility Evaluation Report

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility 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 Maricris Ampuan after introducing self and stating the reason for the visit. Administrator (Admin) Shahin Mokhtarzad shortly arrived on site to assist with the inspection. Admin Mokhtarzad has a valid certificate expiring November 11, 2027.

The following was observed during the inspection accompanied by Admin: This is a single story property located in a residential neighborhood comprised of six private resident bedrooms and six private resident half bathrooms. There is a walk-in community shower shared by all residents. There is an additional private bedroom and full bathroom for the two live-in caregivers. Facility is operating within the conditions and limitations specified on the license. LPA observed six residents in care with one under hospice and another resident who is bedridden. LPA observed two staff present on duty.

LPA toured the physical plant and observed the kitchen appliances and all bathrooms require a deep cleaning The kitchen exterior/interior refrigerator and freezer shelves and doors had food stains and particles. All other common areas were inspected including the attached two car garage. LPA inspected all resident bedrooms. The resident bedrooms' were appropriately furnished, beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage space for each residents' personal belongings were observed. All bathrooms were found be operational but require a deep cleaning. The toilet bowls had fecal matter and urine causing odor, and the bathroom floor and shower had evidence of pink slime or film. Slip resistant mats were observed to be available.