Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with House Manager (HM) Avelina Pascua.

LPA reviewed 3 resident files and 3 staff files.

LPA toured the facility inside and out with HM. License, personal right posters, and administrator certificate were observed in the facility. LPA inspected family room, kitchen, a office, activity room, dinning area, laundry room and garage. Medication closet, knives closet, and cleaning product closet were observed locked. There are 3 shared resident rooms and 2 restrooms in the facility. Room temperature was observed at 68 degree F, and hot water temperature was observed at 115 degree F. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. The facility has emergency light system. The temperature of the freezer was at 0 degree F and the temperature of the refrigerator was at 40 degree F.

The facility is equipped with carbon monoxide detectors and fire alarm system. HM tested the carbon monoxide and fire alarm detectors, and they were working fine. The fire extinguishers were observed on service on 1/5/2026. LPA inspected the backyard, There was no obstruction to block the walkway. The facility conducted fire and fire drill on 1/4/2026 and earth quake drill on 1/3/2026. First aid box was observed in the facility.

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