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 4 residents (R1-R4). 2 staff (S1-S2) and two volunteer (V1, V2). S1 stated ADM comes to facility every day and usually stays 6 hours. ADM arrived the facility about one hour after LPA arrived at the facility. V1 and V2 are not associated with the facility.

LPA toured the facility inside and out with S1 License, Administrator Certificate, and personal rights posters were observed in the facility. LPA reviewed 2 resident file and 2 staff files. 1 out of 2 staff file was observed missing staff training log, ADM stated he/she has that at home, ADM stated to send to LPA by end of today.

Family room, kitchen, dining area, 3 restrooms, a office area, a staff room, 5 resident rooms, and laundry room were inspected. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet was observed locked. Knives closet, and dish washing soap closet were observed unlocked. S1 stated staff were just using it. S1 locked the knives closet and dish washing soap closet immediately. Room temperature was at 76 degree F, and hot water temperature was at 119 degree F in facility. Fire extinguisher was expired, ADM stated the facility will install new one today. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Carbon monoxide detectors were tested by S1, and were working. First aid box, night lights, and flash lights were observed in the facility. The screens in a resident room, and a bathroom.