Facility Evaluation Report

Licensing Prog ram Analyst (LPA) Nancy Guillen made an unannounced visit for the purpose of conducting a required annual Inspection. LPA was greeted and granted entry by care provider after explaining the purpose of the visit. Administrator (AD) Linh Nguyen was notified via telephone and later arrived to assist with the inspection. LPA observed the Administrator certificate was current with and expiration date of January 8, 2027. This is a Residential Care Facility for the Elderly (RCFE) licensed to six non-ambulatory residents, of which one may be bedridden, with a hospice waiver for six. The facility is a one-story home with five resident bedrooms, one staff bedroom, two resident bathrooms, one staff bathroom, and an attached garage with an exterior entrance.

During the inspection, LPA and caregiver conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following:

LPA observed residents watching television in the living room and resting in their respective bedrooms. LPA observed five residents in care and two staff present. LPA observed the See Something Say Something Poster (PUB 475) mounted on the wall in the living room. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets with additional linens stored in a garage storage cabinet. LPA observed bathrooms were clean and equipped with grab bars and non skid floor mats. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 107.6 and 108.8 degrees Fahrenheit. LPA toured the outside of the facility and observed outdoor passageways were free of obstruction. LPA observed the backyard had a shaded sitting area with furniture for resident use.