Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with House Manager (HM) Virginia Quezada. LPA reviewed 2 resident files and 2 staff files. LPA toured the facility inside and out with HM. LPA observed 4 residents and 2 staff in the facility.

License, personal rights posters and Administrator Certificate were observed in the facility. LPA inspected living room, family room, dinning area, kitchen. There are 2 restrooms for residents, a restroom for staff, 2 resident shared rooms, 2 resident single rooms, and 1 staff live-in room in facility. Two days perishable foods and seven nonperishable foods were observed sufficient.

Room temperature was observed at 74 degree F, hot water temperature was observed at 110 degree F. The temperature of the refrigerator was observed at 37 degree F, and the temperature of the freezer was observed at 0 degree F. Medication cabinet, Knife closet, and cleaning products closet were observed locked. Fire extinguisher was serviced on 6/18/2025. The facility was equipped with fire/smoke alarm and carbon monoxide detectors. Carbon monoxide detector was tested, and was working. The facility is equipped with emergency light system and power back up battery system. The facility has call button system for residents. It was tested by HM, and was observed working. First Aid box, and night lights were observed in the facility. The last time the facility conducted the emergency drill was on 11/14/2025. HM stated the facility will start to conduct emergency drill every 3 months.

Front yard and backyard were inspected. There were two gates at back yard to go outside. There was no obstruction to block the walkway. One storage room was observed at the back yard.

This report was provided to HM for signature. A copy of this report was emailed to HM.