Routine inspection·August 16, 2024

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with House Manager (HM) Kim Sullivan. LPA observed 2 staff and 4 residents in the facility. LPA reviewed 2 resident files and 2 staff files. The centrally stored medication forms of 2 resident files were observed inaccurate and not maintained up to date. 2 out of 2 staff files were observed without valid first aid certificate. LPA toured the facility inside out with HM. License, ADM certificate and Personal rights posters were observed in the facility. Living room, kitchen, dinning room and two restrooms were inspected. 3 resident bedrooms, 2 staff live-in rooms and laundry area were inspected. Two staff live-in rooms was observed in facility. Medication closet was observed locked. Knives closet was observed unlocked, HM locked it immediately. The cleaning product closet under the sink was observed unlocked, HM added a lock before LPA finished the inspection. Room temperature was at 70 degree F, and hot water temperature was at 106 degree F in facility. First Aid box, flash lights and night lights were observed in the facility. The last time the facility conducted the emergency drill is 7/6/2024. Two days perishable food supplies and seven days nonperishable food supplies were observed sufficient. Fire extinguisher was serviced on 11/27/2023. 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 and exit. The detached garage was as storage room. Back patio, and side patios were observed at backyard. Deficiencies noted today. See LIC809-D. Exit interview was conducted with HM. This report was provided to HM for signature.