Facility Evaluation Report

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

LPA reviewed 5 resident files and 4 staff files. LPA observed licensee, Administrator Certificate, and personal rights posters at the facility.

LPA toured the facility with HM inside and out. LPA inspected living room, dinning room, kitchen offices, 1 staff restroom, 2 shower rooms, TV room, and 23 resident rooms in the facility. Each resident room has its own restroom. Two days perishable foods and seven day nonperishable foods were observed sufficient. Room temperature was observed at 69 degree F, hot water temperature was observed at 105 degree F. The temperature of the freezer was observed at 0 degree F and the temperature of the refrigerator was observed at 37 degree F. Medication room, laundry room, kitchen were observed locked. The facility was equipped with fire alarm, smoke and carbon monoxide detectors. Carbon monoxide detector was tested, and was working. Fire extinguisher was serviced on 5/20/2025. The fire alarm system test report dated 12/15/2025 was observed. First aid box was observed in the facility. The facility has emergency lighting system.

The last time the facility conducted the fire drill was on 12/15/2025. Front yard and backyard were inspected. There was no obstruction to block the walkways. One storage room with food and refrigerator was observed at backyard.

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