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 a caregiver staff and explained the reason for the visit. Administrators (AD) Kristine Truong and Brenda Truong arrived shortly to assist with the visit. The facility is licensed for a capacity of six, approved for six non-ambulatory, with a hospice waiver of four. Currently there are six residents, and there are two on hospice during today's visit.

LPA Tea reviewed six resident files and four staff files. Resident files contained most of the required documents, except four of the residents does not have updated physician’s report. Staff records met all requirements. The administrator certificate expires on January 17, 2026.

LPA Tea along with staff toured the facility. LPA toured the physical plant, checked food service, and the first aid kit. The home is a one-story facility that consists of 5 resident bedrooms, 2 full bathrooms, living room, kitchen, dining area, and attached garage. 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 shower was free of mold/mildew. Water temperature measured between 108.1 Fahrenheit degrees and 115.5 Fahrenheit degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements