Facility Evaluation Report

Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Required - 1 Year inspection at the facility today. When the LPA arrived there were three staff and five residents present at the home. The LPA met with House Manager Allan Santos and explained the reason for the visit. Administrator Ivy Sudjati arrived approximately at 10:30 a.m.

The LPA and House Manager 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:

KITCHEN : The kitchen and food storage areas were observed. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food stored in the kitchen. Cleaning supplies and items that could pose a danger were secured in locked cabinets. The facility has a supply of emergency food and water. The water temperature was measured at 108.5*F.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and condition. All indoor and outdoor passages were free of obstruction. At the time of the visit, living room, TV room and dining room furniture was observed to be in good condition. The fire extinguisher was fully charged and last serviced on 4/04/2024. At 9:45 a.m. the carbon monoxide detector and smoke detectors were tested and were operational. Medications are centrally stored and in a locked cabinet in the laundry room. Cleaning supplies were observed to be locked in the laundry room and inaccessible to residents in care. The backyard has covered seating for resident use. Fireplace in the living room was covered with a screen.

BEDROOMS: There are five (5) resident bedrooms and one (1) staff bedroom. The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.