Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Virgil Valin. 2 staff and 5 residents (R1 - R5) were observed in the facility. License, personal right posters and ADM certificate were observed in the facility.

LPA checked 3 resident files and 3 staff files.

LPA toured the facility inside out with ADM. Living room, kitchen, dinning room and two restrooms were inspected. Three shared resident bedrooms, and laundry room were inspected. Two staff live-in rooms were observed in facility. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, dish washing product closet, and knives closet were observed locked. Room temperature was at 68 degree F, and hot water temperature was at 111 degree F in facility. The temperature of the refrigerator was at 37 degree F, and the temperature of the freezer was at 0 degree F. Fire extinguisher was serviced on 12/8/2023.

First aid box and flash lights were observed in the facility.

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 working fine. 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 12/04/2023.

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.