Facility Evaluation Report

On 12/20/2023, Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA was greeted by administrator, Amy Lee. LPA explained the purpose of the visit.

LPA toured the facility inside and outside including the bedrooms (4 private rooms), 2 full- bathrooms (one for staff and one for residents), kitchen, and common areas. The facility observed to clean, tidy and in good repair. Bedrooms were equipped with the required furniture for residents to use. Bathrooms are equipped with grab bars, and nonskid mats. Facility temperature is comfortable. Hot water temperature was measured at 108- 111 degrees F.

Central stored medication, toxins and sharps objects were locked and inaccessible to residents.

Staff training records were reviewed; food supplies were observed to be adequate.

Facility is equipped with smoke detectors and carbon monoxide detectors. Fire extinguishers were last serviced on 12/4/2023. Disaster drills records were reviewed.

Staff members at the facility were fingerprint cleared and associated to the facility.

LPA reviewed 3 residents and 3 staff records. Resident records contain admission agreement, medical assessment, LIC 602 (Physician Order), Appraisal Needs and Service Plan, GGRC/IPP, etc. Staff files contain personnel records, health screening, COVID-19 vaccination card, Job Description, Abuse Statement, First Aide, CPR, Criminal Record Statement etc.