Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit and met with Hector Marquez, Program Coordinator (PC) and Administrator (ADM) Mauna Morris.

During visit, LPA toured the facility inside and out with PC. 5 clients and 2 staff were observed in the facility. PC stated 9 clients went out with 3 staff.

License, personal rights posters were observed in the facility. The facility restroom had available soap and paper towels. The water temperature was measured at 107 F. The outdoor exit was clear of obstructions.

Fire extinguisher was serviced on 11/25/2024. The facility was equipped with fire alarm system, and carbon monoxide detector. carbon monoxide detector was tested by PC, and was working fine.

LPA requested LIC500. Based on the review of LIC500, LPA did not see staff S1. PC provided the names of the staff at the facility and the staff took clients out, no staff match the name of S1. ADM stated in September 2024, the facility received notice from the Department that S1 is not eligible to work at the facility. ADM stated the facility never hires S1 as employee, and S1 never worked at the facility.

LPA reviewed 5 resident records and 5 staff records. One resident's Appraisal Needs and Service Plan was observed did not update since 2021.

The facility was unable to provide the emergency/fire drill log document.

Deficiencies noted for today's inspection visit. See LIC809-D for more information.

This report was reviewed with PC and a copy of this report and appeal rights were provided.