Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Clinic Manger Bory Kham (BK).

LPA checked 5 client files and 5 staff files. The staff files were found incomplete at the facility.

LPA toured the facility with BK. License, Administrator Certificate and Personal rights were observed at main entrance. LPA toured the dining area and kitchen. 2 days perishable food supplies and 7 nonperishable food supplies were observed sufficient. LPA toured the Administration unit and resident units with BK. There are 4 resident units and two 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. Cleaning products room, knives box, medication rooms were observed locked.

Room temperature was at 72 degree F. Hot water temperature was measured at 110 degree F. The temperature of the refrigerator was measured at 40 degree F, and the temperature of freezer was measured at 0 degree F.

Fire extinguisher was serviced on 01/04/2023. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by BK, and were working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways. The facility had emergency and fire drill on 10/23/2023.

Deficiencies noted today. See LIC809-D. Exit interview was conducted with BK. A copy of this report was provided to BK.