Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced Required 1 Year visit and met with House Manager Loren Garcia. LPA observed 1 staff at the facility. All 3 residents went to day program.

LPA reviewed 2 resident files and 2 staff files. 2 Out of 2 residents' appraisal needs and service plan were observed completed more than one year ago.

License, ADM certificate, and posters of personal rights were observed in the facility.

LPA toured the facility with HM inside and out. LPA inspected living room, family room, dinning area, kitchen, and garage. There are 2 restrooms, 3 resident shared rooms, and 2 staff live-in rooms in facility. At least two days supplies of perishable foods and seven days supplies of nonperishable foods were observed. Fire extinguisher's service date was observed on 5/13/2024. Room temperature was observed at 74 degree F, and hot water temperature was observed at 114 degree F.

Medication cabinet, knife closet, and dish washer liquid closet were observed locked. Facility smoke detectors and carbon monoxide detectors were in working condition. The last disaster drill was conducted on 01/01/2025. First aid box, night lights, and flash lights were observed in the facility.

Front yard and back yard were inspected. No obstruction was observed to block the walkway.

Deficiencies noted today. See LIC809-D. Exit interview was conducted with HM. This report was provided to HM for review and signature. A copy of the report was provided to HM.