Routine inspection·August 5, 2022

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with House Manager (HM) Vaoese Niko. Upon arrival, HM took LPA body temperature, and checked LPA in the visitor log book. LPA toured the facility inside out with HM. COVID posters were observed at main entrance and the facility. Screening station with masks, hand sanitizer, thermometer and visitor log book was observed at the main entrance. Family room, office, kitchen, dinning area and two restrooms were inspected. All trash cans were observed with covers. Paper towel were observed with holders. Four resident bedrooms, and laundry area were inspected. Two staff live-in rooms are in facility. Cloth towels were observed in kitchen and restrooms. No posters of washing hands for 20 seconds were observed by the sinks in kitchen and restrooms. HM stated the facility will put the posters of washing hands for 20 seconds by the sinks in 3 days. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, knives closet, and cleaning product closet were observed locked. Room temperature was at 74 degree F, and hot water temperature was at 112 degree F in facility. Two residents and 3 staff were observed in facility. Fire extinguisher was serviced on 10/02/2021. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by HM, and were working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways. HM stated all the residents and staff are fully vaccinated and done with booster. No citation were noted today. Exit interview was conducted with HM. This report was provided to HM for signature.