Facility Evaluation Report

Unannounced annual visit made out to this facility on 10/15/2021 by this LPA Charlie Yang who was met by the facility caregivers. A brief interview was conducted with the caregivers who were present at this time. This LPA requested that the caregivers go ahead and contact the facility designated Administrator, Ada Osuka, to inform her that CCL was present at this time. The facility designated Administrator arrived later on while this LPA was present.

Current census was 5 residents who were all present since their respectable day programs were unavailable due to COVID restricted activities at this time.

This facility is licensed to serve and accept up to 6 residents who are deemed to be ambulatory and (1) non ambulatory as well. This facility is vendorized to accept and retain Level 4I residents at any given time.

Dining area, living areas, and all other areas intended for resident use were toured. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time.

Kitchen area was toured. Cabinets and storage units for cook ware and kitchen ware were observed to be sufficient and able to meet the needs of the residents at this time.

Food storage units, facility refrigerator unit and freezer unit, were reviewed for adequate 2-day perishable and 7-day non perishable quantities at this time. Pantry area housing dry goods and products was toured. Medication cabinet was reviewed. Policies and procedures were discussed with the facility designated Administrator in regards to dispensing, documenting, and communication for all involved parties.

First aid kits were observed to be present and contained all of the required components at this time.

Fire extinguishers were observed to have been annually inspected on 05/21/2021 by the local fire equipment company and found to be in compliance at this time.

A tour of the resident bedrooms was conducted. Bedroom furniture and furnishings were observed to be sufficient and in compliance at this time.

It was observed that all of the resident bedrooms were private and none of them were shared at this time. A tour of the facility staff room was toured as well.