Facility Evaluation Report

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at 10:08 A.M. The LPA was greeted by Caregiver Ari Lutfi Mahendra and informed the reason for the visit. Caregiver contacted the Administrator by phone, Shila Pandey. At 10:25 A.M. the Administrator arrived at the facility. At 10:38 A.M., the back-up Administrator, Karthiga Vijayakumar joined the visit. LPA explained the reason for the visit. Entrance interview conducted.

Beginning at 10:48 A.M., the LPA along with the Administrator and back-up 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:

Hardwired smoke detector and Carbon Monoxide detectors were tested at 11:41 A.M. and were functional at the time of the visit. LPA observed one (1) fully charged fire extinguisher purchased on 10/28/2024.

BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 7 (seven) bedrooms in total; 1 (one) of which is designated as a staff room and 6 (six) are private resident rooms. Staff room was observed locked. There were no visible hazards or discrepancies observed.

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 slip-resistant surfaces. Water temperature were measured in all bathrooms and measured within the required range of 105 degrees Fahrenheit to 120 degrees Fahrenheit at the time of the visit.