Facility Evaluation Report

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

LPA observed 3 staff and 4 residents. LPA reviewed 3 client file and 3 staff files.

License, ADM certificate, and personal rights posters were observed in the facility. The ADM certificate was observed expired, ADM show his/her ADM Certificate is on the active list online.

LPA toured the facility with ADM inside and out. LPA inspected living room, family room, dinning area, kitchen, exercise room, and garage. There are 2 restrooms, 1 staff live-in room, and 3 resident rooms in facility. Two days perishable foods and seven day nonperishable foods were observed sufficient. The temperature of the refrigerator was observed at 37 degree F and the temperature of the freezer was observed at 0 degree F. Room temperature was observed at 70 degree F, hot water temperature was observed at 119 degree F.

Medication cabinet, knife closet were observed locked. Cleaning products closet was observed locked. The facility was equipped with smoke and carbon monoxide detectors. Smoke detector alarm system was tested, and was working fine. Fire extinguisher was serviced on 4/15/2024. The dimmer light system was observed in the hallway. Flash lights and first aid box were observed in the facility. The last time the facility conducted the emergency drill is 11/16/2024.

Front yard and backyard were inspected. There was no obstruction to block the walkways.

No citation was issued today. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of this report was provided to ADM.