Facility Evaluation Report

On 01/16/2024, Licensing program Analyst (LPA) Jaime Vado conducted an unannounced required - 1 year inspection. LPA met with Caregiver Siliilani Leleivuna and explained the purpose of today’s visit. Currently there are 6 residents and 2 caregivers present. During the visit caregiver called the administrator to inform her of LPAs presence. During the visit the administrator Sophia Chen arrived and met with LPA.

This is a single level facility with 6 bedrooms for residents. The facility is licensed for age 60 and over. 6 non-ambulatory. Hospice waiver granted for 3 residents. Currently there are no hospice residents. LPA Vado toured the facility both inside and outside. All outdoor and indoor passageway are free and clear of obstructions for emergency exit routes in case of fire or emergency. Facility's ambient temperature is comfortable for residents and LPA. No pools or bodies of water were observed during today's visit on the premises. LPA observed fresh food supplies and emergency one week of nonperishable and two (2) days of perishable foods as in place. There is a freezer located in the garage and a full refrigerator and freezer in the kitchen. Canned food supplies are primarily observed as stored in the garage. Knives are locked in the kitchen in a drawer and below the sing cleaning supplies are locked. Toxic chemicals are stored in the garage primarily. Cleaning supplies and laundry soaps are also locked in the garage. Laundry area is in the garage and both the washer and dryer are operational. PPE and incontinence supplies are observed to be in place. Medications are locked in the kitchen in a large upper cubbard. Each resident room is observed to contain the required furniture as outlined in regulations. Facility has functioning smoke detectors and carbon monoxide detectors through out the facility. LPA Observed a fire pull station located at the front of the facility near the front door. The facility is equipped with 2.5 bathrooms. Room 3 contains its own half bath. There are two other full bathrooms with showers in the facility. All are observed in good working order for resident use. Water temperature is tested at 110F in all three bathroom sinks. There are three fire extinguishers in the facility that is observed with inspection tags of 11/20/2024