Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Clinic Manger Bory Kham (BK). Upon arrival, the front desk checked LPA's body temperature, and checked LPA in the visitor log book.

LPA toured the facility with BK. LPA observed the COVID posters at the main entrance and in facility. LPA toured the dining area and kitchen. LPA toured the Administration unit and resident units with BK. There are 4 resident units and one staff unit. Each resident unit has a big living room, Med office, Laundry room, rest rooms and office area. Unit A has 5 shared rooms and 2 single rooms. Unit B has 3 shared rooms and 4 single rooms. Unit C has 4 shared rooms and 2 single rooms, Unit D has 5 shared rooms and 3 single rooms. The current census is 39. The trash cans in common area were observed without covers. BK stated the facility will put all the trash cans in common areas with covers in 15 days. The posters of washing hands for 20 seconds were observed by the sinks in restrooms.

LPA checked the PPE supplies. PPE supplies were observed sufficient. LPA checked the food supplies. 2 day perishable food supplies and 7 day food supplies were observed sufficient. COVID-19 related posters were observed in the facility. Staff were observed wearing masks. Room temperature was at 72 degree F.

Fire extinguisher was serviced on 02/11/2022. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Front yard and backyard were inspected. There was no obstruction to block the walkways.

BK stated all staff and residents are fully vaccinated. The facility already submitted the Infection Control Plan to LPA.

No allegation was issued today. Exit interview was conducted with BK. A copy of this report was provided to BK.