Facility Evaluation Report

On March 11, 2026, Licensing Program Analysts (LPAs) Cassie Yang and Kerry Hiratsuka arrived unannounced at the facility to conduct a required annual inspection utilizing inspection. LPAs met with Administrator and explained the purpose of the visit.

There are five clients in care, facility is approved for six non-ambulatory residents. Hospice waiver for four. LPA Yang provided Administrator an updated copy of facility license.

Today's inspection, LPAs and Administrator conducted a tour of the interior of the facility to ensure the health and safety of residents in care. LPAs LPAs observed facility to have the required compliance poster posted in the common area. LPAs observed fire extinguishers present throughout the facility, fire extinguishers were recently serviced on December 9, 2025. LPAs observed paint supplies and medications in a vacant room. The following was asked to be removed and properly stored away. LPAs observed a chain lock on the front door, LPAs were informed facility does not utilize the lock. LPAs observed chain lock to be removed during LPAs' visit. Administrator was advised that excess walkers and wheelchairs should be disposed and/or stored in an area other than the common area.

At this time, LPAs obtained a copy of Licensee Mortgage Interest Statement. LPAs are requesting a copy a liability insurance, LIC 308 and LIC 500. LPAs were unable to complete today's inspection. A case management visit annual continuation visit will be conducted in the future. All observations today remain under review.

Exit interview conducted and a copy of report was provided.