Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with House Manager (HM) Joseph Oliva. LPA toured the facility inside and out with HM. License, Administrator Certificate, and personal rights posters were observed in the facility. 3 residents and 2 staff were observed in the facility. 2 residents went to day program. LPA reviewed 2 resident file and 2 staff files.

Family room, living room, kitchen, dining area, 2 restrooms, and laundry room were inspected. 6 single resident bedrooms, 2 restrooms, and 2 staff rooms were inspected. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, knives closet, and chemical closet were observed locked. Room temperature was at 71 degree F, and hot water temperature was at 116 degree F in facility.

Fire extinguisher was serviced on 4/18/2026. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Carbon monoxide detectors were tested by HM, and were working. First aid box, and flash lights were observed in the facility. Front yard and backyard were inspected. There was no obstruction to block the walkways. The last time the facility conducted the emergency and fire drill was on 4/10/2025. The emergency drill should be done quarterly. The centrally stored medication form of resident R2 was observed inaccurate and not up to date.

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