Facility Evaluation Report

At 7:53am, on 9/11/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Backup Administrator Chong Kim, announced who he was and the reason for the visit.

Backup Administrator and LPA conducted a full tour of the facility. This facility is a single-story residential home with four single occupancy client bedrooms and a full shared bathroom for client use. The primary bedroom is a live-in staff bedroom with full on-suite bathroom for staff use. There is a living room, dining area, office area, and a kitchen. LPA noted a fireplace in the living room the Backup Administrator stated it is not used. Access to the laundry room and garage is through a locked door for client safety. LPA noted that the backyard has seating and shade for clients to enjoy freely. There is fresh fruit and snacks in the kitchen for clients to enjoy. The facility has battery operated smoke detectors in each bedroom and hallway leading to bedrooms that are all working, the carbon monoxide detector is in the hallway and functioning normally. LPA observed a fire extinguisher near the kitchen that was tagged current and in the green compression range, serviced on 4/22/2025. LPA tested facility hot water at 114.8*(f), within regulation temperatures 105*-120* (f). LPA observed at least 2 - days of perishable and at least 7 - days of nonperishable foods. LPA noted that the facility is clean with no obstructions in hallways or doorways. Medications are locked in a cabinet near the kitchen. Staff and client files are locked in the living room. LPA conducted a medication audit and reviewed the facilities Centrally Stored Medication Records, finding no violations. LPA conducted a staff and resident file review.

LPA and Backup Administrator conducted a review of the annual care tool modules. There were no deficiencies cited at this time.

Exit interview conducted, report signed, and report provided to the Backup Administrator.