Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection, and met with licensee Thelma Blanchard (LCN) and Administrator (ADM) Michelle Bayquen.

1 staff and 3 residents were observed in the facility. License, personal right posters, ADM certificate were observed posted at the main entrance. ADM certificate was observed expired. ADM stated he/she renewed it. LPA checked online on the website, Administrator's ADM certificate is in active list.

ADM stated the facility is a RCFE with MI residents. 2 resident file and 2 staff files were reviewed.

LPA toured the facility inside out with ADM. Dinning room, kitchen and family room were inspected. 4 resident bedrooms and 2 restrooms were inspected. 1 office and 1 staff room were observed in the facility. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet was observed locked. Knives closet, and dish cleaning product closet were observed unlocked. ADM fixed the issues before LPA finished the visit. First aid box was observed in the facility. Room temperature was at 70 degree F and hot water temperature was at 119 degree F. resident bedroom #1 and #4 were observed little and waste scattered on the floor. ADM stated the 2 residents did not like staff to clean their room when they were at the rooms.

Fire extinguisher was serviced on 9/23/2024. The facility was equipped with smoke and carbon monoxide detectors. Carbon monoxide detector was tested and was working fine. Front yard and backyard were inspected. Some boxes were observed at side of the building to block the walkways. ADM immediately removed the boxes. A storage room was observed at the backyard. ADM stated the last the facility conducted the emergency and fire drill was 11/7/24.

Citations were noted today. See LIC809-D. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of this report was provided to ADM