Facility Evaluation Report

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to continue a Required Annual Inspection which began on 03/17/2025. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Staff Eleanor Bautista.

According to the facility’s license, the facility has a maximum capacity of four (4) clients, of whom all must be ambulatory. According to LIC602 Physician’s Reports, staff interviews, and LPA observation: During this annual inspection, there were a total of four (4) clients in care, and all were ambulatory, per their respective doctors. The facility’s license did not include endorsements for delayed-egress doors or secured perimeter, and neither of these were present.

During this inspection, LPA toured the interior and exterior of the facility and inspected all common areas and bedrooms. LPA performed a welfare check on clients in care and interviewed multiple staff. LPA also reviewed the care and administrative records for all clients and the personnel and training files for all active staff. 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 showers were working. Extra linens, hygiene, and Personal Protective Equipment (PPE) 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 70 F. Hot water temperature at taps accessible to clients were all compliant: Kitchen Sink was 107.8 F, Bathroom #1 Sink was 107.8 F, and Bathroom #2 Sink was 106.3 F. Appliances to preserve perishable food were also complaint in temperature: Kitchen Refrigerator was 38 F, Garage Refrigerator was 39 F, and both Kitchen and Garage Freezers were 0 F. There were at least (2) days of perishable food and at least seven (7) days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present and in good condition. [CONTINUED ON LIC809-C]