Facility Evaluation Report

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced 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 Lilia Yanit. LPA then met with Administrator Jerijan Antonio, who arrived shortly after.

According to the facility’s license, the facility has a maximum capacity for four (4) clients, of whom all may be ambulatory and up to two (2) clients may be non-ambulatory, but none may be bedridden. Per LPA observation and review of each client’s latest LIC602 Physician’s Report: During today’s visit, there were a total of four (4) clients in care, of whom all were ambulatory. This facility’s license does not include endorsements for secured perimeter or delayed egress doors, and none of these were present during the visit.

During today’s visit, LPA interviewed multiple staff and clients. LPA also reviewed all staff and client records/files. LPA, accompanied by Licensee’s staff, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in general good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens, hygiene supplies, and Personal Protective Equipment were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was complaint at 70 F. Hot water temperature at taps accessible to clients were all compliant: Kitchen Sink was 110.3 F, Bathroom #1 Sink was 110.1 F, and Bathroom #2 Sink was 107.4 F. Appliances to preserve perishable food were also compliant in temperature: Kitchen Refrigerator was 39 F and Kitchen Freezer was 0 F. Garage Refrigerator was 39 F and Garage Freezer was 0 F. There was at least two (2) days of perishable food, and at least seven (7) days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. [CONTINUED ON LIC 809]