Facility Evaluation Report

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

LPA toured the facility inside and out with ADM. License, Administrator Certificate, and personal rights posters were observed in the facility.4 staff were observed in the facility. LPA reviewed 3 resident file and 3 staff files.

Living room, kitchen, dining room, restrooms, and laundry room were inspected. 4 single resident bedrooms, 1 shared resident bedrooms, and a staff room/office were inspected. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet and knives closet were observed locked. Dish washing chemical cabinet was observed unlocked. ADM locked the dish washing chemical cabinet before LPA finished the visit. Room temperature was at 68 degree F, and hot water temperature was at 112 degree F in facility. The temperature of the refrigerator was at 40 degree F. One of the resident room's screen window was observed missing. No flash lights was observed in the facility. No night light was observed in the facility hall way or restroom, ADM installed a night light and got the flash light before LPA finished the visit.

Fire extinguisher was serviced on 05/1/2024. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors were tested by ADM, and were working fine. First aid box was observed in the facility. Front yard and backyard were inspected. There was no obstruction to block the walkways. ADM stated the last time the facility conducted the emergency and fire drill was on 1/17/2024.

Deficiencies were 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.