Facility Evaluation Report

Licensing Program Analyst (LPA) Dang Nguyen and Licensing Program Manager (LPM) Robyn Clark conducted an unannounced visit to conduct a Required Annual Inspection. LPA and LPM were welcomed by, identified themselves to, and discussed the purpose of the visit with Caregiver Alita Reyes. LPA and LPM then met with Licensee Henrietta "Candy" Chong, who arrived later during the visit.

According to the facility’s license, the facility has a maximum capacity of six (6) clients, of which all may be ambulatory, three (3) may be non-ambulatory, and one (1) may be bedridden. Per LIC602 Physician’s Reports, staff interviews, and LPA/LPM observation: During today’s inspection, there were a total of six (6) clients in care, and all were ambulatory. The facility’s license does not include endorsements for delayed-egress doors or secured perimeter, and neither of these were present.

During today’s visit, LPA and LPM performed a welfare check on all clients in care, interviewed multiple facility staff and clients, and reviewed records for all clients and active staff. LPA and LPM, accompanied by the Licensee, also toured the interior and exterior of the facility, and inspected all common areas and resident bedrooms. During the inspection, the Department observed these hazardous items in areas that were accessible to clients: two (2) sharp cooking knives, two (2) cans of paint, two (2) small bottles of cleaning chemicals, one (1) container of disinfecting wipes, and one (1) bottle of 91% isopropyl rubbing alcohol. [These items were handed to staff and locked away during today’s visit.]

The facility was in good repair and bedrooms and common areas were mostly clean, except for Bedroom #2 [occupied by Client #1 (C1) and Client #2 (C2)], where two (2) spider cobwebs (each over one foot long) were observed on a wall and ceiling, and a three-dimensional build-up of dust was observed on the window blinds and ceiling fan. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] The cobwebs and dust were cleaned up during today's visit. Three (3) trash cans did not have tight-fitting covers, as required. [CONTINUED ON LIC 809-C]