Facility Evaluation Report

On October 7, 2025, at 9:30 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Staff Dung Pham.

The facility is licensed to operate for six (6) nonambulatory residents of which two (2) may be bedridden and have a hospice waiver for two (2) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, three (3) bathrooms, living area, dining area, kitchen, two (2) outdoor covered seating areas, and an attached two car garage used as a staff lounge.

LPA Kim toured inside and outside of the physical plant with Staff Pham. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between 115.7 degrees F and 116.2 degrees F. A comfortable temperature of 74 degrees F was maintained in the facility.