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 Imelda Navarro and explained the reason for the visit. Licensee/Administrator (Admin) Hanh Pham arrived on site to assist with the visit. Admin holds a valid certificate expiring on October 30, 2025.

The facility is a single story structure is licensed to provide services for age range 60 and over for six non-ambulatory. A waiver was granted to provide hospice services to four residents at one time. During today's visit, there are no residents under hospice care and two staff providing care to five residents.

LPA toured the physical plant with Caregiver Ma Alojado. Facility is clean and operational. LPA observed five resident bedrooms and three resident bathrooms. There is one additional staff bedroom occupied by two live in staff. Resident bedrooms had all required furnishings. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 115.3, 108.3, and 112.4 degrees Fahrenheit in the resident bathrooms. All common areas were inspected including the attached two car garage. LPA reviewed the Emergency Disaster Plan (LIC610E) last updated on March 13, 2022 and observed sufficient emergency food and water in the garage and kitchen pantry, however not all disaster supplies were obtained as noted on the LIC610E. 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 and garage. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. The exit gate is self-closing and self-latching. LPA observed sufficient seating and shading.