Facility Evaluation Report

On 4/19/2022 at 8:50 AM, Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct an annual inspection visit. Prior to entering the facility, LPA Truong called and spoke to staff who confirmed no clients or staff have had any symptoms of COVID-19 in the last 10 days. LPA met with Co-Administrator Justin Nitta and explained the purpose of today’s visit. The purpose to today's visit is to redo the annual inspection which was conducted on 1/26/2022 was not within 60 days prior to the anniversary date.

Administrator holds current certification #6008957735 and expires on 11/28/2023. The facility is licensed to serve 6 ambulatory developmentally disabled adults. Age range 18 through 59 years. There are currently 6 clients who reside at this facility. LPA toured the facility with Justin Nitta on 4/19/2022 at 9:05 AM.

LPA inspected the physical plant including but not limited to the common area, kitchen, pantry, dining area, client bedrooms, client bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. The hot water temperature was observed to be 119.7 degrees Fahrenheit, which is within the required regulation of 105 to 120 degrees Fahrenheit. Facility thermostat observed at 72 degrees Fahrenheit. Food supply is adequate for 2-day perishable and 7-day nonperishable.