Routine inspection·May 31, 2023

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Assist Administrator (AADM) Melanie Gavina. Staff Nercisa Cabrera (S1) and Evelyn Bergunia (S2) and 5 residents (R1 - R6) were observed in the facility. LPA checked 5 resident files and 3 staff files. LPA toured the facility inside out with ADM. Living room, family room, kitchen, dinning room and 4 restrooms were inspected. 2 shared resident bedrooms, 2 single resident rooms, and laundry area were inspected. One staff live-in room was observed in facility. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, and knives closet and cleaning product closet were observed locked. Room temperature was at 72 degree F, and hot water temperature was at 116 degree F in facility. Fire extinguisher was serviced on 5/10/2023. The temperature of freezer was observed at 0 degree F. The temperature of refrigerator was observed at 30 degree F. One of the screen of the bed room was broken. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors and carbon monoxide detectors were tested by ADM, and they were working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways. Deficiency was found. LIC809-D and Appeal Rights were attached. Exit interview was conducted with AADM. This report was provided to AADM for signature. A copy of the report was provided to AADM.