Facility Evaluation Report

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

LPA checked 5 resident record files (R1 - R5) and 3 staff record files (S1 - S3). 2 residents (R1 - R2) and 2 staff (S2 - S3) were interviewed.

LPA toured the facility inside out with ADM. COVID posters were observed in the facility. Facility license, Personal Right posters were observed in the facility. Living room, family room, kitchen, dinning room and three restrooms were inspected. Paper towel were observed with holders. Cloth towels were observed in the kitchen and restrooms. Six single resident bedrooms, and laundry room were inspected. Two staff live-in rooms were 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. But one knife was observed left at the kitchen sink. Room temperature was at 70 degree F, and hot water temperature was at 109 degree F in facility.

Fire extinguisher was serviced on 4/18/2023. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors and carbon monoxide detectors were tested by ADM, and were found no batteries. ADM changed the batteries immediately. Front yard and backyard were inspected. There was no obstruction to block the walkways.

Deficiencies were found today. LIC809-D were attached. Appeal Rights were attached. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of the report was provided to ADM.