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 Administrator Jerijan Antonio.

According to the facility’s license, the facility has a maximum capacity for (4) clients, of whom two (2) may be non-ambulatory, but none may be bedridden. Per LPA observation, LIC602 Physician’s Reports, and administrator interview: During today’s inspection, there were a total of four (4) clients in care, and all were ambulatory. LPA interviewed multiple staff and multiple clients. LPA also reviewed the care records for all clients, and the personnel files for all staff. LPA, accompanied by the administrator, also toured the interior and exterior of the facility and inspected all common areas and bedrooms.

The facility was clean, sanitary, and in good repair. 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. The facility’s ambient internal temperature was complaint at 72 F. Where tested, hot water temperature at taps accessible to clients were compliant in temperature . Appliances to preserve perishable food were also compliant in temperature. Cooking/dining equipment and utensils were present and in good condition.