Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Enrico Aguas.

All 5 residents were at day program. LPA reviewed 3 resident files and 3 staff files. One resident R1's medications is mismatched with the central stored medication form for 7/9/2024 PM medication, and the MAR does not document what happen for it..

LPA toured the facility inside out with ADM. License and personal rights posters were observed at main entrance. LPA observed expired Administrator Certificate, ADM provided the documents that he/she renewed the Administrator Certificate.

Living room, family room, kitchen, dinning area and two restrooms were inspected. Three shared resident bedrooms, garage, 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, knives closet, and cleaning product closet were observed locked. Room temperature was at 76 degree F, and hot water temperature was at 108 degree F in facility.

Fire extinguisher was serviced on 08/02/2023. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways. Flash lights, first aid box and night lights were observed in the facility. The last time the facility conducted the emergency drill is 6/10/2024.

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.