Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an annual inspection visit, and met with House Manager (HM) Olivia Lazo. Upon arrival, HM took LPA body temperature and checked LPA into the guest book. Screening station with thermometer, masks, hand sanitizer was observed at the main entrance. COVID posters were observed at the main entrance and in facility. 2 staff and 4 residents were observed in facility.

LPA toured the facility inside out with HM. LPA inspected living room, kitchen, dinning area, and laundry room. Medication closet, knives closet, and cleaning product closet were observed locked. There are 4 rooms for residents, and one staff live-in room in facility. 3 bathrooms are in facility. Paper towels were observed with holders, Trash cans were observed with covers. Room temperature was observed at 73 degree F, and hot water temperature was observed at 113 degree F. 2 days perishable food supplies and 7 days non perishable food supplies were observed sufficient.

The facility is equipped with smoke and carbon monoxide detectors. The facility equipped with fire alarm. HM tested the smoke and carbon monoxide detectors, and they were working fine. The fire extinguishers were observed on service on 01/29/2023. LPA inspected the backyard, there was no obstruction to block the walkway.

HM stated all staff and residents are fully vaccinated and done with booster. The facility already submitted the Infection Control Plan.

No deficiency noted during inspection. Exit interview was conducted with HM. This report was provided to HM for signature.