Facility Evaluation Report

At approximately 9:15AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required 1 Year visit and met with Staff Member, Yibing (Shelley) Li. Administrator/Licensee, Qiuming (Robert) Zhai, arrived during visit at approximately 9:30AM. Facility is an Adult Residential Home that provides care and assistance for Adults with Disabilities. Facility has an approved fire clearance for 3 Ambulatory clients and 1 Non-Ambulatory client for a total capacity of 4 clients. Upon arrival, LPA was informed that there were 2 clients in care with one client out of the facility attending Day Program. LPA was also informed that there was two staff members on-site.

At approximately 9:20AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 9:35AM, LPA conducted a walk-though of the facility with Administrator/Licensee. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a single story building with 2 Client bedrooms, 2 bathrooms, a staff room, an office room, and common areas. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for clients. Mattress pads were in place or available for client use. Toxins were observed to be stored inaccessible to clients. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit.

At approximately 10:00AM, LPA reviewed staff files, client files, client medication, and client P&I monies. All files were all found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. P&I monies were documented, secure and not commingled. During medication review, LPA observed that the facility uses a written Medication Authorization Record (MAR) and a centrally stored log. LPA observed that some medications were not documented on the log as required. Review of facility's log indicated that facility understands how to document medications appropriately. LPA and Administrator/Licensee discussed reviewing how to correctly log medications when they arrive to the facility (see technical violation, LIC9102, regulation 80075(k)(7).