Facility Evaluation Report

Licensing Program Analyst Steve Chang conducted an Annual Inspection and met with program manager/administrator (ADM)Mohammad Esmael Darman and assistant program manager Nancy Maldonado. Upon arrival at facility, the front office staff took LPA body temperature and asked the infection control questionnaires, and checked in LPA in the visitor log book. LPA observed COVID-19 posters in the facility. Screening station with thermometer, masks, hand sanitizer was observed at the main entrance. LPA observed staff wore the mask. Rosters of staff and residents are obtained.

ADM stated the current census is 10. LPA toured the facility inside out with ADM. There are 10 resident rooms including 4 single rooms and 6 shared rooms. LPA observed the beds in the shared rooms were 6 foot apart. Break room, Admin office, living room, community room, storage room, Med room, staff offices were observed. Dinning room, 3 restrooms and kitchen were observed and inspected. ADM stated the means for residents were served at different time to avoid all residents have the meals at the same time. 2 days perishable food supplies and 7 days nonperishable food supplies were observed sufficient. All trash cans were observed with covers. Not all sinks with washing hands poster. ADM stated the facility will fix the issue in 2 days. All paper towels were observed either with dispenser or with holders. ADM stated the residents are only allowed to smoke outside the building. Room temperature was observed at 70 degree F, and hot water temperature was observed at 115 degree F.PPE supplies were observed sufficient. ADM stated all staff and residents were fully vaccinated and done with booster.

No citation were issued during today's inspection. Exit interview conducted with ADM. This report was provided to ADM to review and to sign.