Facility Evaluation Report

Licensing Program Analysts (LPAs) Ruth Martinez and Taylor Simerly arrived unannounced for the purpose of conducting the Required 1-Year annual evaluation. LPA was greeted and granted entry by the caregiver and explained the reason for the visit. Administrator Hanh Pham holds a valid certificate expiring on October 30, 2027.

The facility is a single story structure 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. There currently are six residents of which one resident is currently receiving hospice care services.

LPAs began the tour of the inside and outside of the facility. LPAs observed required department postings throughout the facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food storage in a two spare refrigerator in the garage. The facility is maintained at a comfortable temperature. LPAs inspected that medication is centrally stored in a safe locked storage cabinet located in the kitchen in front of the pantry. LPAs reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPAs observed the first aid kit. LPAs inspected the facility bathrooms and LPAs measured the hot water temperature which measured 112.4 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Lighting is sufficient to ensure safety and comfort. The facility is equipped with sufficient hand