Facility Evaluation Report

On 4/16/26, Licensing Program Analyst (LPA) Kyle Wellington arrived unannounced to the facility to conduct an annual inspection. LPA met with the Administrator (Admin), Tuyen Nguyen, who was informed of the purpose of the visit. LPA observed 0 (zero) staff and zero (0) clients present at the facility. The census at the facility is three (3) client s. LPA toured the inside and outside of the facility with the Admin. LPA conducted an observation and record review for the inspection.

Facility Overview: The facility is a one story house with four (4) bedrooms, two (2) bathrooms, kitchen, living room, dining room, family room, laundry room and attached garage. There are no pools, bodies of water or firearms at the facility. The facility has a fire clearance to serve three (3) ambulatory and one (1) non-ambulatory clients.

Infection Control: LPA observed soap dispensers in the bathrooms and in the kitchen. Cleaning equipment was kept locked in the garage and cleaning supplies were kept in a locked cabinet under the kitchen sink and available for regular facility maintenance. LPA reviewed the facility’s infection control plan which met the department’s requirements.

Physical Plant: LPA observed the inside and outside of the facility to be clean, safe and well kept. The floors, windows and doors were clean and well maintained. The living room, family room and dining room furniture was in good repair. The bedrooms and halls had night lights and the halls were free of obstruction. The residents’ bedrooms were neat, organized and had the required bedding and furniture. Bathrooms were clean, tidy and contained non-slip floors in the showers. The hot water temperature in the bathroom was

measured at 108.0 F. Clean linens and towels were readily available in the facility. Laundry equipment appeared to be in good working condition. The one (1) fire extinguisher was charged and tested on 9/8/25