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 Nancydita “Nancy” Gala. LPA then met with Administrator Eva Paras, who arrived shortly after.

According to the facility’s license, the facility has a maximum capacity for six (6) residents, of whom all may be ambulatory or non-ambulatory, but none may be bedridden. Per LPA observation, LIC602 Physician’s Reports, and staff interviews: During today’s inspection, there were a total of three (3) residents in care, and all were non-ambulatory status. The facility’s license does not include endorsements for delayed-egress doors or secured perimeter doors, and neither of these were present.

LPA, accompanied by Licensee’s staff, toured the interior and exterior of the facility and inspected all common areas and resident bedrooms. LPA interviewed all residents in care, and multiple staff. LPA reviewed care records for all residents, and personnel records for all active staff.

During the facility tour, LPA observed, and manager interview confirmed: The facility’s dedicated telephone line was non-working. [During today's visit, Licensee contacted their phone service provider to make an 09/04/2025 appointment to remedy this.] The facility’s fire extinguisher had not been professionally serviced/inspected since 2022. (This was required to be done annually.) Where tested, hot water temperature at taps used by residents were initially too cold: Bathroom #1 Sink was 98.6 F, Bathroom #2 Sink was 98.6 F, and Bathroom #3 Sink was 98.2 F. [CONTINUED ON LIC 809-C, 1 of 2]