Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Designated Administrator (ADM) Melanie Gavina. 2 staff were observed in the facility. 4 Residents went to day program. LPA checked 2 resident files and 2 staff files.

LPA toured the facility inside out with ADM. Living room, family room, kitchen, dinning room and 4 restrooms were inspected. 4 single resident rooms, and laundry area were inspected. One staff live-in room was observed in the 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 69 degree F, and hot water temperature was at 106 degree F in facility. Fire extinguisher was serviced on 6/8/2025. The temperature of freezer was observed at 0 degree F. The temperature of refrigerator was observed at 30 degree F. First aid box, night lights, and flash lights were observed in the facility. The last time the facility conducted the earth quake drill was on 1/3/26 and the fire alarm drill was on 1/4/26.

The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors and carbon monoxide detectors were tested by ADM, and they were working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways. One storage room was observed in the backyard.

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