Facility Evaluation Report

On November 26, 2024, at 8:50 AM, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. LPA met with the staff members S1 and S2 and disclosed the purpose of the inspection. Administrator, Becky Bi arrived shortly after. The administrator informed the LPA that the facility currently has 6 residents in care, with 4 of them are non-ambulatory and 2 residents are on hospice.

At 9:20 AM, the LPA initiated a walk-through of the facility, accompanied by the administrator.

At 9:22 AM, the LPA inspected the kitchen and found it clean, with no food preparation or cooking in progress at the time. A bottle of dish washing soap was observed placed on the sink. The LPA checked the appliances and observed them in working order. The LPA inspected the refrigerator and pantry cabinets and observed enough supplies of fresh perishable food for (2) days and nonperishable staples for (7) days. No expired food and no stored medications were noticed.

At 9:30 AM, the LPA observed knifes and scissor kept in an unlocked kitchen cabinet and accessible to residents in care. LPA observed Comet bleach and Clorox disinfectant wipes in a closet underneath the kitchen sink and accessible to residents in care.

At 9:38 AM, LPA inspected the dining area and observed it clean, with all the furniture in good repair. There was a dining table and enough chairs to accommodate all the residents. The LPA inspected the fire extinguisher mounted on the wall and found it was fully charged with last a service tag of 02/06/2024. The administrator tested the smoke and carbon monoxide detector located in the hallway in the LPA's presence, and it was found to be functional. Additional smoke and carbon monoxide detectors were observed in all bedrooms and common areas of the facility during the visit.