Facility Evaluation Report

On 08/29/2025 at approximately 09:50AM, Licensing Program Analyst (LPA) Ali Deniz arrived unannounced to continue 1-Year Required visit of this licensed Adult Residential Facility (ARF). LPA was greeted by House Manager, Rhoda Venkaiya. Administrator, Zina Lee arrived later during the inspection. Facility has an approved fire clearance and capacity for 4 ambulatory residents. Upon arrival, LPA was informed that there were 3 residents in care which 3 of them were attending a day program and 1 staff member on-site. Facility is a 1 story building with 3 Resident bedrooms, 1 staff bedroom, 3 bathrooms, and common spaces.

At approximately 10:10AM, LPA reviewed 2 resident records and found 2 out of 2 residents did have current physician's reports, care plans, signed admission agreements, and physician's orders on file. Medication records are thorough and contained physician's orders for each resident.

At approximately 11:05AM, LPA reviewed 3 staff records. 3 of 3 records did contain documentation of completed training records as required. Evidence of first aid and CPR training were current. However, 2 out of 3 staff members did not have complete annual training in files (Technical Advice Given). Administrator agrees to submit proof of correction by 09/11/2025

LPA was presented with proof of current CPR & 1st Aid certification for staff.

Administrator Certificate is for Zina Lee #7034386735 expires on 11/30/2026. Facility has supplies enough to operate for more than 72 hours in an emergency.