Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Dieu-Qui Nguyen .

LPA observed 3 residents and 3 staff in the facility. LPA toured the facility inside and out with ADM. License, Administrator Certificate, and personal rights posters were observed in the facility.

LPA reviewed 2 resident file and 2 staff files.

Family room, kitchen, dining area, 3 restrooms, 1 office area, 2 staff rooms, 4 resident rooms, and laundry room were inspected.

Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. The temperature of the refrigerator was observed at 40 degree F, and the temperature of the freezer was observed at -1 degree F. Medication closet was observed locked. Knives closet, and dish washing soap closet were observed locked. Room temperature was at 75 degree F, and hot water temperature was at 119 degree F in facility. Fire extinguisher was observed without date, staff went to buy new one and installed in the facility. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Carbon monoxide detectors were tested by ADM, and were working. First aid box, night lights, and flash lights were observed in the facility.