Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Virgil Valin. Staff Erlinda Asuncion (EA) and Arlene Esteban (AE) and 5 residents (R1 - R5) were observed in the facility.

LPA checked 5 resident files and 2 staff files.

LPA toured the facility inside out with ADM. Living room, kitchen, dinning room and two restrooms were inspected. Trash cans were observed with covers. Paper towels were observed with holders. Three shared resident bedrooms, and laundry room were inspected. One staff live-in room was observed in facility. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, and knives closet were observed locked. Cleaning products under the sink in the kitchen were observed unlocked. Room temperature was at 70 degree F, and hot water temperature was at 111 degree F in facility. Fire extinguisher was serviced on 12/7/2022.

The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors and carbon monoxide detectors were tested by ADM, and were found out of battery. Front yard and backyard were inspected. There was no obstruction to block the walkways.

Some deficiencies were found. LIC809-D and Appeal Rights were attached. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of the report was provided to ADM.