Facility Evaluation Report

At 10:50 a.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 shortly thereafter at 11:00 a.m. and was explained the reason for the visit.

At 11:00 a.m. the LPA conducted a tour of the physical plant with the Administrator 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, and three (3) restrooms (2 private and 1 communal). The LPA observed one (1) fire extinguisher which was fully charged and last serviced on 03/23/2026. At 1:10 p.m. all smoke alarms and carbon monoxide detectors were tested and functioned properly. The LPA observed all required postings throughout the facility.

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.

Bedrooms: All 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. The hot water temperature in two of the resident restrooms measured at 121.8 and 121.1 degrees Fahrenheit. Report will continue on LIC809-C.