Facility Evaluation Report

LIcensing Program Analyst (LPA) Jill Nakagawa arrived on 09/11/2024 for the purpose of conducting a Pre Licensing Inspection. LPA was met at the front door by care staff and granted access to the facility; Administrator Ron-Mark Adriano arrived shortly. There were 2 care staff at the time of inspection and there were 4 residents in care. Fire Clearance approved for 6 with 5 being non-ambulatory in any room; hospice waiver for 5. Ron-Mark Adriano will be the Administrator, Administrator's Certificate # 7024492740, effective 02/26/2023 - 02/25/2025.

LPA and Administrator toured the one story facility, which has 5 bedrooms, 2 bathrooms, and family room/ dining area and kitchen. LPA observed the facility to be clean and at a comfortable temperature of 74 degrees F with all exits free from obstruction. LPA found the 2 carbon monoxide detector to be operational during the inspection. The 2 fire extinguishers were last serviced on 03/29/2024 and fully charged and operational. First Aid kit was inspected and found to be complete. Water temperature was 112.2 - 114.6 degrees F and is within acceptable range of 105 to 120 degrees F. There were sufficient perishable and non-perishable foods located in the kitchen. Knives and other hazardous items were locked and inaccessible to residents in care. Medications are locked in cabinet in living room where it is inaccessible. Cleaning products and other toxins are locked in laundry room and locked cabinet in garage and inaccessible to residents in care. There was a supply of linens, cleaners, hygiene products and paper products available for residents. Bathrooms were supplied with paper towels and hand soap, and outfitted with grab bars and non-slip floors/mats. A tour of all resident bedrooms was conducted, and bedrooms inspected have lighting and appropriate furnishing.