Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Shirley Richards. LPA toured the facility inside and out with ADM. License, Administrator Certificate, and personal rights posters were observed in the facility.

Two residents and two staff were observed in the facility. LPA reviewed 3 resident file and 3 staff files.

Living room, kitchen, family room, dinning room and two restrooms were inspected. Two single resident bedrooms, two shared resident bedrooms, and laundry room were inspected. One staff live-in room is in facility. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, knives closet were observed locked. Dishing cleaning product closet was observed unlocked. ADM locked it immediately . Room temperature was at 68 degree F, and hot water temperature was at 104 degree F in facility, ADM adjusted the hot water temperature on site. The hot water temperature was observed at 108 degree F before LPA finished the visit.

Fire extinguisher was serviced on 04/18/2024. ADM bought new fire extinguisher and installed it before LPA finished the visit. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were working fine. First aid box and flash lights were observed in the facility. No night light was observed in the facility. ADM bought new night lights and installed them before LPA finished the visit. Front yard and backyard were inspected. There was no obstruction to block the walkways.

ADM stated the last time the facility conducted the emergency and fire drill was on 3/20/2024.

Deficiencies were noted today. See LIC809-D. Exit interview was conducted with ADM. This report was provided to ADM for signature.