Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with House Manager (HM) Senen Semana. LPA checked 5 residents files and 5 staff files. One of the staff does not have health screening form. HM stated the facility will have the staff to complete the health screening check.

LPA toured the facility inside out with HM. License and Personal Rights posters were observed at the main entrance. Living room, family room/dining room, kitchen, 3 shared resident bedrooms, 2 staff room, 2 resident restrooms, 1 staff restroom and laundry room were inspected. Nonskid pads were observed in the restrooms. Cloth towels were observed in the restrooms and kitchen. Medication closet, detergent closet, and knives closet were observed locked. One knife was observed left at kitchen counter, HM stated she just went to open the door for LPA. All the bedrooms were observed with window screens. First Aid kit was observed in facility. The kitchen window was observed without screen. The battery powered lighting for emergency lighting was observed ran out of battery

Two day perishable food supplies and Seven day nonperishable food supplies were observed sufficient. Room temperature was observed at 83 degree F. Hot water temperature was observed at 106 degree F. Refrigerator temperature was observed at 40 degree F. Freezer temperature was observed at 0 degree F.

Fire extinguisher was serviced on 05/08/2023. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by HM, one of the carbon monoxide detectors ran out of battery. LPA toured backyard with HM. A storage room was observed at the backyard. There is no obstruction to block exit at the backyard.

Exit interview was conducted with HM. LIC809-D and Appeal Rights were attached. The report was provided to HM for signature. A copy of the report was provided to HM.