Facility Evaluation Report

Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Required Annual Inspection. LPA was met at and granted entry into the facility by Eddie Nguyen, Licensee, to whom LPA disclosed the purpose of the visit.

According to the facility’s license, the facility is licensed for a maximum capacity of four (4) clients, all of whom must be ambulatory. During today’s inspection, there were four(4) clients in care.

LPA, accompanied by the licensee, toured the interior and exterior of the facility, and inspected each room. The facility was clean and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors and equipment inspected were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. Hot water temperature at sink accessible to clients measured at 120 degrees Fahrenheit.

Refrigerator and freezer were operational and had sufficient space to store perishable items. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible.

No pools or bodies of water were observed on the premises. Per the licensee, no firearms or ammunition are kept or will be stored in the facility. Smoke alarms were in working order. Fire extinguisher was present. First aid kit was complete and readily accessible. Required licensing postings were available for posting in a visible area of the facility.

No deficiencies were cited during today's annual inspection.

An exit interview was conducted with Eddie Nguyen, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the end of the visit.