Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 10:54AM. LPA initially met with facility staff; Administrator Edwin Paul Oyasan arrived shortly after the visit began. Entrance interview conducted.

Beginning at 11:03AM, the LPA, along with 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 combination smoke and carbon monoxide detectors were tested at 01:09PM and were functional at the time of the visit. Fire extinguisher was observed to be fully charged and last serviced on 04/25/2024.

BEDROOMS: There are 4 (four) total bedrooms; 3 (three) are for private resident use and 1 (one) is designated for shared use. The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. 2 (two) full bedrails were observed on Resident #1 (R1)'s bed and 1 (one) full bedrail was observed on Resident #2 (R2)'s bed. Neither R1 nor R2 are on hospice.

RESTROOMS: The LPA observed 2 (two) restrooms in the facility; 1 (one) is for shared use and 1 (one) is designated for private resident use. Resident restrooms were observed to be clean and sanitary and in operating condition with grab bars and non-skid surfaces. Water temperature was measured in both resident restrooms and measured within the required range.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. A fireplace was observed in the living room to be adequately screened and inaccessible to residents in care. Auditory exit alarms were functional at the time of the visit. Report Continued on LIC 809-C