Facility Evaluation Report

Licensing Program Analysts (LPAs) Steve Chang and Simi Rai conducted an unannounced annual inspection visit. LPAs met with Administrator (ADM) Evira Casim and stated the purpose of today's visit.

LPAs observed 1 staff S1 in the facility. Two out of two residents went to day program.LPAs reviewed 5 staff files and 2 residents file.LPAs toured the facility inside and out with ADM and S1.

License, ADM certificate, and personal right posters were observed at the main entrance. 3 shared resident rooms, 2 restrooms were inspected. 3 shared resident rooms were observed unlocked. Kitchen, dining room, family room, 1 office, and garage were inspected. Room temperature was measured at 71 degree F. Hot water temperature was observed at 113 degree F. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. The expiration dates of the food in the refrigerator were checked, there was nothing found expired. The cans in the storage cabinet of pantry food were checked, there was nothing found expired. Medication closet, knives closet, and cleaning product closet were observed locked. The temperature of the freezer was observed at 0 degree F and the temperature of the refrigerator was observed at 35 degree F.

Fire extinguisher was serviced on 01/6/2025. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Carbon monoxide detector was tested by S1, and as working. The last time the facility conducted the fire drill was on 4/1/2025. Emergency light and flash lights were observed in the facility. First aid box was observed in the facility.