Facility Evaluation Report

At 02:20 p.m. Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by staff and informed them of the reason for the visit. Administrator Ivy Sudjati arrived approximately around 4:15 p.m.

At 2:39 p.m. the LPA conducted a tour of the physical plant with House Manager Alan Santos to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: Facility is a single-story residence that consists of five (5) resident bedrooms (one currently vacant), and three (3) restrooms. The LPA observed one (1) fire extinguisher which was fully charged and last serviced on 04/04/2024. All smoke alarms and carbon monoxide detectors were tested and functioned properly. The LPA observed all required postings throughout the facility. LPA informed administrator that their annual licensing fee is not current. Administrator stated they will be paying the licensing fee today.

Kitchen : The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of perishable and non-perishable food at the facility. Food is prepared based on the menu. Snacks and beverages are always available for the residents. At 2:41 p.m. the LPA observed an unlocked box that stores the kitchen knives on the counter top to the left of the stove. Upon observation, staff stated the box had been left unlocked for an hour and locked the box.

Bedrooms: The resident bedrooms were properly furnished with at least one chair, nightstand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding.

Bathrooms: The LPA observed all bathrooms, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats in all bathrooms. At 03:43 p.m. water temperature in resident’s restroom in room #2 was measured at 108.1 degrees Fahrenheit. Report will continue on LIC809-C.