Facility Evaluation Report

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility announced at 12:30 p.m. to conduct a pre-licensing inspection. The LPA met with applicant Edwin Paul Oyasan. This is a new facility application for (6) six residents’, (2) two rooms are cleared for non-ambulatory residents, (2) two rooms are cleared for ambulatory residents and (1) one bedroom is cleared for a bedridden resident. The fire clearance was granted on 5/12/2023. Component III was completed today with the LPA.

At 12:45 p.m., the LPA toured the physical plant areas inside and outside with applicants to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN : Kitchen knives are stored locked and inaccessible in a kitchen cabinet on the right-hand side of the refrigerator. Cleaning supplies are locked inaccessible under the kitchen sink. The supply of perishable and nonperishable food is adequate. The supply of dishes is adequate. Appliances in the kitchen were clean and appeared functional. There is an adequate supply of emergency food and water.

BEDROOMS : There are (5) five bedrooms in the facility; the facility has (4) four private bedrooms for resident use and (1) shared bedroom for resident use there is no staff room, and the facility has a den that is used as office space for staff. All resident rooms have direct access to the outside. Lighting in the rooms appeared adequate. (3) out out of (5) five resident rooms were set up with beds, night stands, lamps, chests of drawers, chairs and closet space. Administrator indicated they would be furnishing the empty rooms immediately.

BATHROOMS : There are (2) two full bathrooms; one bathroom is located in Bedroom #1 and the 2 nd bathroom is located in the main hallway. (2) two of (2) two resident showers are equipped with nonskid surfaces and available nonskid mats.