Facility Evaluation Report

Licensing Program Analyst’s (LPA) Alyssa Ramirez conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Licensee Josefina So.

The facility is currently licensed for a maximum capacity of four (4) clients, of which three (3) may be non-ambulatory. During today’s inspection, there were a total of four (4) clients in care.

LPA, accompanied by staff, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Client bedrooms contained the required furnishings. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. Hot water temperature was compliant. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas.

No pools or bodies of water were observed on the premises. Smoke alarms, carbon monoxide detectors, emergency lighting, facility telephone, fire extinguisher and first aid kit were present. Required licensing postings were observed in visible areas of the facility.

LPA reviewed multiple staff and client records/files. Files reviewed contained required documents. Required licensing postings were observed in visible areas of the facility.

No deficiencies were cited during today's annual inspection.

An exit interview was conducted with So to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.