Facility Evaluation Report

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Caregiver Brendalyn Partosan, Administrator Charlz Partosan and Owner Joseph Li arrived shortly after. According to the facility’s license, the facility has a maximum capacity of six residents, of whom all may be non-ambulatory and 6 may be bedridden with a hospice waiver for 6. This is a two story building but not approved for residents upstairs.

LPA toured the interior and exterior of the facility and inspected each room. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities.

Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medication was pre poured into a separate container for multiple times of the day for all three residents. Water temperature was measured at 108 degrees F.

No pool or body of water present. Per Joseph, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguishers were present. First aid kits were complete and readily accessible. Resident records reviewed had required documentation.

One deficiency was cited on today's visit in regards to medication being transferred from container.

An exit interview was conducted with Administrators and Owner, to whom a copy of this report, the LIC809 D and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.