Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with House manager (HM) Jalano Valenzuela.

LPA observed 1 residents and 3 staff in the facility. LPA checked 3 resident files and 3 staff files.

LPA toured the facility with HM. License, Administrator Certificate and Personal right posters were observed in the facility. There are one staff break room in the facility, 2 resident shared rooms, 2 resident single room, and 2 restrooms in the facility. Grabbing bars and Non skid mats were observed in the bathrooms. LPA toured the kitchen, dining room, family room, and garage. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. The room temperature was 72 degree F, and the hot water temperature was 119 degree F. The temperature of the refrigerator was measured at 33 degree F, and the temperature of freezer was measured at -5 degree F. Medication cabinet was observed locked. Cleaning chemical products cabinet under the sink was observed unlocked. The facility locked it immediately. Knives cabinet was observed locked. Fire extinguisher was serviced on 10/17/2024. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by HM, and were working fine. First aid box, flash light for emergency, and night light were observed in the facility. The facility fire and emergency drill was conducted on 10/3/2024.

LPA toured backyard with HM. No obstacles were observed blocked the walkway in the backyard. A storage room was observed in the backyard.

Deficiency noted today. See LIC809-D. Exit interview was conducted with HM. The report was provided to HM for signature. A copy of the report was provided to HM.