Facility Evaluation Report

At approximately 3:05 PM, Licensing Program Analyst (LPA) Jill Nakagawa made an unannounced annual required inspection of this licensed senior care facility, licensed for 7 residents.

LPA met with House Manager Paulin Pantig and toured the building which was found to be clean and in good repair. LPA toured the grounds and observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored in a locked storage closet. Water temperature measured within regulation between 105 and 120 degrees F at faucets accessible to residents. Fire extinguishers inspected were fully charged. Smoke detectors were found to be in working order. Carbon Monoxide detectors were present. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure.

LPA reviewed 5 of 6 resident records. All records contained current and signed admission agreements and current physician reports. Medication records are thorough and contained physician's orders for each resident. LPA reviewed 4 personnel files and found them complete, including all training and up-to-date with First Aid.

No deficiencies were found at the time of inspection.

Exit interview conducted with Paulin Pantig. Copy of report left at facility.