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 Julie Sombria. LPA then met with Licensee/Administrator Henrietta "Candy" Chong, who arrived shortly after.

According to the facility’s license, the facility has a maximum capacity for six (6) clients, of whom up to one (1) may be bedridden and up to two (2) may be non-ambulatory. Per LPA observation, LIC602 Physician’s Reports, and staff interviews: During today’s inspection, there were a total of six (6) clients in care, of which five (5) were ambulatory and one (1) was non-ambulatory. LPA interviewed staff and observed clients. LPA also reviewed the care records for all clients, and the personnel and training files for all active staff. LPA, accompanied by staff, 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 shower were all 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 73 F. Where tested, hot water temperature at taps accessible to clients were compliant in temperature: Kitchen Sink was 118.4 F, Bathroom #1 Sink was 116.4 F and Bathroom #2 Sink was 115.2 F. Appliances to preserve perishable food were also compliant in temperature. Cooking/dining equipment and utensils were present and in good condition. [CONTINUED ON LIC 809-C]