Facility Evaluation Report

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Noe Contreras. LPA also met with Licensee Maria “Angie” Rose, who arrived later during the visit.

According to the facility’s license, the facility has a maximum capacity of five (5) clients, of which all may be ambulatory or non-ambulatory, but none may be bedridden. Per LIC602 Physician’s Reports, staff interviews, and LPA observation: During today’s inspection, there were a total of four (4) clients in care, and all were non-ambulatory. The facility’s license does not include endorsements for delayed-egress doors or secured perimeter, and neither of these were present.

During today’s visit, LPA performed a welfare check on all clients in care, interviewed multiple facility staff, and reviewed records for all clients and active staff. LPA, accompanied by the Licensee, also toured the interior and exterior of the facility, and inspected all common areas and resident bedrooms. The facility was in good repair and bedrooms and common areas were clean, except for LPA observing one (1) live roach in the facility’s kitchen area. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were working. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities.