Facility Evaluation Report

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at 9:00 A.M. The LPA was greeted by Caregiver Charlin Sitompul and informed the reason for the visit. Caregiver contacted the Administrator by phone, Shila Pandey. At 9:50 A.M. Administrator arrived at the facility, LPA explained the reason for the visit. Entrance interview conducted.

Beginning at 10:25 A.M., the LPA along with Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

Combination smoke and Carbon Monoxide detector was tested at 11:14 A.M. and was functional at the time of the visit. LPA observed one (1) fully charged fire extinguisher purchased on 03/21/2023. Administrator will buy a replacement and send proof to LPA.

BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 7 (seven) total bedrooms; 1 (one) of which is designated as a staff room and 6 (six) are private resident rooms. Staff room was observed locked. No client bedroom will be used as a public or general passageway to another room, bath, or toilet. There were no visible hazards or discrepancies observed. LPA observed that facility is not using appropriate waste receptacle with a tight-fitted cover.

RESTROOMS: The LPA observed 3 (three) restrooms in the facility; 2 (two) are shared restrooms and one is a private restroom. Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Water temperatures were measured in all client bathrooms and measured within the required range of 105 degrees Fahrenheit to 120 degrees Fahrenheit at the time of the visit.