Facility Evaluation Report

On 4/13/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Thelma Tan, Administrator and explained the purpose of the visit.

LPA toured the physical plant. This is a 1-story with 5 bedrooms, 3 bathrooms, a kitchen, living room, dining room, garage, backyard, and second building that the Administrator and Licensee live in.(No residents live in the second building) No accessible bodies of water or hazards were observed. All bedrooms had the required furniture and sufficient lighting. The facility's hot water temperature was measured within the required 105-120 degrees Fahrenheit. The facility's smoke alarms and carbon monoxide detectors were observed to be in working order. The facility's fire extinguisher was observed to be fully charged and last checked in June 2025. The facility had the required 7 days of non perishables and 2 days of perishables. No food was expired. The facility's first aid kit was observed to have all of the required items.

All sharp objects, soap, detergents, and poisons were observed to be locked and in-accessible to persons in care.

LPA reviewed 5 resident files and 6 staff files. All were observed to be complete except S1, S2, S3 and S4's files were missing active CPR/First Aid certificates. A Type B citation was issued for this deficiency.

In addition, during record review, LPA Calandra observed that R1's Ambulatory status is listed as bedridden and the facility does not currently have fire clearance for bedridden patients. A Type B citation was issued for this deficiency.