Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Divina Fernandez.

LPA toured the facility inside and out with ADM. License, Administrator Certificate, and personal rights posters were observed in the facility. 6 residents and 3 staff were observed in the facility. LPA reviewed 3 resident file and 3 staff files. ADM cannot provide the document for the facility liability insurance. Living room, kitchen, dining room, restrooms, 6 resident rooms, and garage were inspected. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, knives closet were observed locked. Dish washing solution bottle was observed on the kitchen sink counter, ADM locked it immediately. Room temperature was at 73 degree F, and hot water temperature was at 106 degree F in facility. The temperature of the refrigerator was at 38 degree F, and the temperature of the freezer was at 0 degree F.

Fire extinguisher was serviced on 07/18/2025. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Carbon monoxide detectors were tested by ADM, and were working. First aid box, night lights, and flash lights were observed in the facility. Front yard and backyard were inspected. There was no obstruction to block the walkways. There are 2 storage rooms at the backyard. There has no log for the emergency drill or fire alarm drill. ADM stated he/she does not remember when was the last time the facility conducted the emergency drill or fire alarm drill.

Deficiency noted today. See LIC809-D. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of the report was provided to ADM.