Facility Evaluation Report

This is an amended report from Annual Inspection conducted on 02/13/24 to remove LIC809D.

Licensing Program Analyst Steve Chang conducted an unannounced annual Inspection and met with program manager/administrator (ADM) Mohammad Esmael Darman.

Licensee, personal rights posters, and administrator certificate were observed at the main entrance.

LPA observed 8 staff and 16 residents in the facility. 5 resident files and 5 staff files were reviewed.

LPA toured the facility with ADM. There are 10 resident rooms including 4 single rooms and 6 shared rooms. Copy room/Break room, administrative office, manager office, staff offices, clinician office, living room (TV room), community room, laundry room, storage room, Med room and doctor office were observed in facility. Dinning room, 3 restrooms and kitchen were observed and inspected. 2 days perishable food supplies and 7 days nonperishable food supplies were observed sufficient. Room temperature was observed at 70 degree F, and hot water temperature was observed at 118 degree F. The temperature of refrigerator was at 38 degree F, and the temperature of the freezer was at 0 degree F. Medication supplies were observed locked in the Med room. Med room was observed locked. Knives were observed locked in kitchen. Detergent supplies were observed locked in the storage room.

Fire extinguisher was serviced on 2/10/2024. The facility is equipped with fire alarm, smoke and carbon monoxide detectors. ADM tested the smoke and carbon monoxide detectors, and they were working fine.

The facility's last emergency and fire drill was conducted on 2/5/2024.

No deficiency cited during today's visit.