Facility Evaluation Report

Licensing Program Analyst Steve Chang conducted a POC case management visit to clear deficiencies cited on August 28, 2025, during the annual inspection. LPA met with staff Jano Fonokalafi (S1). LPA explained the purpose of the visit to S1.

The Facility was cited the following Type A deficiencies on August 28, 2025

87303(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors

87355(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility:

LPA received the plan of correction by the POC due date.

LPA observed 2 staff (S1, S2) and 5 residents in the facility.

LPA toured the facility inside and out with S1.

LPA observed all the window screen are fixed.

LPA checked S1 and S2 are associated with the facility. LPA did not see any other staff in the facility.

S1 stated the two volunteers LPA observed on 8/28/2025 do not appear at the facility since 8/29/2025.

S1 stated ADM already processed the procedure of associating the 2 volunteers.

Deficiencies cleared during todays visit. POC cleared letter provided to ADM.

S1 read the report to ADM and signed the report on behalf of ADM.

No Deficiencies was cited during todays visit. This report was reviewed by S1 .

A copy of this report was provided to S1.