Facility Evaluation Report

Licensing Program Analysts (LPA) Kerry Hiratsuka conducted this unannounced annual visit.

This facility has a fire clearance for four non-ambulatory residents. This facility does not have a staff bedroom so the facility is required to have awake staff at all times. The main driveway has an area enclosed by a fence and there is are two gates: one for pedestrians that will not be locked and a gate that is across the driveway. There is also parking for cars on the other side of the gate. When facing the front of the facility there is a detached garage on the left side that is for staff break area and training and has locked cabinets for staff and resident records. It also may be used to check visitors into the facility and is large enough to hold meetings as well. The facility has a door across from the detached garage that enters into a laundry nook area of the facility. The main entrance opens to a small foyer. There is a closet to the immediate right side. There is a hallway just past the entrance that leads to both sides of the facility. Across the hallway leads to the main common area and the kitchen and dining nook is on the left. There are locked cabinets for sharps and such in the kitchen. To the left of the main entrance is a hallway that leads to a laundry area that has locked cabinets across the clothes washer and dryer, a full common bathroom, and one of the resident bedrooms that has an exit to the outside. There is a doorway leading to the main area across the bathroom. To the right of the main entrance there is a hallway that leads to three resident rooms, a full common bathroom, a medication storage area that has locked cabinets for medications, and a door leading to the outside that is across the medication area. The backyard was inspected. There are gates on both sides of the facility. There is a locked storage shed in the back right corner of the property. There is a covered patio with furniture. There is a walking path in the backyard for residents.

The following shall be updated and submitted to Community Care Licensing Division by May 16, 2024:

-LIC 308 designation of administrative responsibility

-LIC 500 facility personnel or staff schedule