Facility Evaluation Report

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

LPA observed 2 staff (S1, S2) and 1 resident (R1) in the facility. LPA reviewed 3 resident files (R1 - R3) and 3 staff files (S1 - S3).

LPA toured the facility with S1 inside and out. License, personal rights posters, and Administrator Certificate were observed in the main entrance. Living room, dining room, garage and kitchen were inspected. 1 staff live-in room was observed in the facility. 3 resident bedrooms, 2 bathrooms were inspected. One of the bathroom did not have the non skid mat.

Two days perishable foods and seven day non perishable foods were observed sufficient. Room temperature was observed at 70 degree F, hot water temperature was observed at 113 degree F. Medication cabinet, Knife closet, and cleaning products closet were observed locked. Fire extinguisher was serviced on 11/09/2023. The facility was equipped with fire alarm system and carbon monoxide detectors. Fire alarm and smoke detector alarm system were tested, and were working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways.

First aid box, flash lights were observed in the facility. ADM stated the facility conducted the emergency drill on 12/22/2023.

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