Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) MARIA CECILIA CLARIDAD . LPA checked 4 resident record files (R1 - R4) and 5 staff record files (S1 - S5). 4 residents (R1 - R4) and 2 staff (S1 - S2) were interviewed.

LPA toured the facility inside and out with ADM. Facility license, Administrator Certificate, and Personal Rights posters were observed posted at the facility. A screening station with masks, hand sanitizer, glove, thermometer and visitor log book was observed at the main entrance.

Living room, kitchen, dinning room and two restrooms were inspected. 4 single resident bedrooms, 1 shared resident bedroom, and laundry room were inspected. 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 68 degree F, and hot water temperature was at 112 degree F in facility. Cloth towel were observed at kitchen. No night light was observed in the hall way.

Fire extinguisher was serviced on 05/03/2022. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by staff, and were working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways.

Exit interview was conducted with ADM. This report was provided to ADM for signature. LIC809-D, LIC9102, and Appeal Rights were attached.