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 inside out with ADM. License, personal rights posters, and Administrator Certificate were observed in the facility. 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. A half bed rail was observed on a bed of resident room for resident R1, ADM provided document to support the needs of R1.

Two days perishable foods and seven day non perishable foods were observed sufficient. Room temperature was observed at 71 degree F, hot water temperature was observed at 105 degree F. Medication cabinet, knife closet were observed locked. Dish cleaning soap solution was observed on the top of kitchen sink, ADM locked the dish cleaning soap solution immediately. Fire extinguisher was serviced on 10/13/2024. The facility was equipped with fire alarm system and carbon monoxide detectors. Fire alarm and carbon monoxide detectors were tested, and were functional. First aid box, and flash lights were observed in the facility. No night light was observed in the hallway. ADM put a night light in the hallway immediately. The last time facility conducted the emergency drill was on 12/18/2024.

Front yard and backyard were inspected. One storage room was observed at the backyard. There was no obstruction to block the walkways.

Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of this report was provided to ADM.