Facility Evaluation Report

On 11/21/2024 at 4:35pm, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct a Case Management visit. LPA met with Ding Wang, Administrator, and explained the reason for the visit.

While LPA L. Hall was conducting a complaint investigation 15-AS-20241120130942 on 11/21/2024. During tour of facility LPA observed the following deficiencies.

LPA observed, a reverse door knob on room # 5 was locked and R1 was inside.

LPA observed room #6 door was locked, when open LPA observed (S4) male sitting on the bed in room

LPA observed during record review R1 did not have an admission agreement, consent for medical treatment, and emergency contact and identification.

LPA observed during record review facility did not report hospitalization for R1.

LPA observed during review of R1's medication that three (3) medication was missing.

*An immediate civil penalty of $250.00 will be assessed on today's date for a repeat violation and $200.00 for fingerprint. A total of $450.00.