Facility Evaluation Report

LIcensing Program Analyst (LPA) Jill Nakagawa arrived for the purpose of conducting a Pre Licensing Inspection. LPA was met at the front door by care staff and was granted access into the facility. Fire Clearance approved for 6 nonambulatory, 1 of which may be bedridden (in Bedroom #4 only). Victoria Haller, Administrator was out of town. LIcensee was available by phone. Lucille (Chiqui) Calimpon (LC), House Manager/Administrator -in-Training and 2 additional care staff were on site at the time of inspection. There were 5 residents in care.

LPA and LC toured the one story facility, which has 5 bedrooms, 2.5 bathrooms, and large family room 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 detectors and 8 smoke detectors to be operational during the inspection. The fire extinguisher was last charged on April 16, 2024 and was fully charged and operational. First Aid kit was inspected and found to be complete. Water temperature was within acceptable range of 105 to 120 degrees F. There was sufficient perishable and non-perishable foods located in the kitchen and freezer in the garage. Knives and other hazardous items were locked and inaccessible to residents in care. Medications are locked in hall closet and inaccessible to residents in care. Cleaning products and other toxins are located in the locked laundry room and inaccessible to residents in care. There was a supply of linens, cleaners, hygiene products and paper products available for residents. All bathrooms designated for residents 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.