Facility Evaluation Report

Licensing Program Analysts (LPA) Christine Wong conducted the required annual inspection. LPA arrived unannounced and met with caregiver Kevin Qin. Assistant administrator Anna Dong assisted with the visit and Administrator, Linda Fan , also arrived to assist the visit at around 11:00am. The purpose for the visit was explained. The facility is licensed for residents age range 60 and over. Approved for 29 non-ambulatory and 14 bedridden, Hospice Waiver for 10.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following 12 domains:

1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. COVID-19 screening is still in place. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan.

2. Operational Requirements: The facility has a dementia care plan to accept or retain residents with dementia. Currently they have 6 hospice residents reside in the facility. The facility has the sufficient amount for liability insurance covering injury to residents and guests.

3. Physical Plant and Environmental Safety : The facility is a two story building, on the first floor, it includes: Reception area, common area (Read newspaper area and exercise area), Administrator office, Dining Area, Kitchen, linen supply room, cleaning supplies room, ten (10) residents bedrooms, laundry room, food storage room and two unisex public bathrooms. On the second floor, it includes seventeen (17) residents bedrooms, rest area (TV and computer room), public bathroom but currently used it as storage. The facility also has a large back patio area. The passag eways, walkways and patios are free from obstructions. On today's annual, LPA inspected five (5) residents bedrooms which include Room#101, #126, #128, #206 and #227.