Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced pre-licensing inspection visit and met with Administrator (ADM) Abdullah Kaykha.

LPA toured the facility inside out with ADM. Personal Rights posters and Administrator Certificate were observed at the main entrance. Office, dining room, kitchen, 3 shared resident bedrooms, 2 restrooms, and laundry room were inspected.

Room temperature was observed at 71 degree F. Hot water temperature was observed at 102.9 degree F. ADM agreed to adjust the water temperature. Refrigerator temperature was observed at 36 degree F. Freezer temperature was observed at 0 degree F. All the bedrooms were observed with window screens.

Fire extinguisher was serviced on 05/18/2023. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were working fine. Medications closet was observed locked. Knives closet was observed locked. Detergent closet under the kitchen sink was observed not locked. The detergent closet in the garage was observed locked. ADM agreed to add a lock for the closet under the sink.

Nonskid pads were observed at the bathrooms. Night light was observed at the hallway. LPA toured the backyard with ADM. No obstruction were observed at the backyard. LPA discussed the infection Control Plan with ADM. Component III was conducted with ADM.

Exit interview was conducted with ADM. The report was provided to ADM for signatures. LIC809-D and Appeal Rights were attached. The reports were provided to ADM.