Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted a unannounced annual inspection visit and met with Licensee Pam Sloan (LNS) and House manager (HM) Teresita Dela Pena.

LPAs checked 3 resident record files and 3 staff record files.

LPA observed 3 residents and 3 staff in the facility.

LPA toured the facility inside out with LNS. LPA inspected living room, kitchen, dinning area, and laundry room. Medication closet, knives closet, and cleaning product closet were observed locked.

There are 3 shared resident rooms at first floor for residents, and 2 restrooms at first floor. There is 1 office in the first floor and 1 staff live-in room at the second floor in facility. Room temperature was observed at 72 degree F, and hot water temperature was observed at 114 degree F. The temperature of refrigerator was observed at 30 degree F, and the temperature of the freezer was observed at 0 degree F. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. First aid box, flash lights, and night light were observed in the facility. The last time the facility conducted the emergency drill is 6/2/2024.

The facility is equipped with smoke and carbon monoxide detectors. The facility equipped with fire alarm system. LNS tested the smoke and carbon monoxide detectors, and they were working fine. The fire extinguishers were observed on service on 05/31/2024. LPA inspected the backyard, there was no obstruction to block the walkway. There is a detached garage at the backyard which was used as staff room.

Exit interview was conducted with LNS. LIC9099-D and Appeal Rights were attached. The reports were provided to LNS for signature. A copy of this report was provided to LNS.