Facility Evaluation Report

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents of which one may be bedridden. Facility has an approved hospice waiver for 3 residents and the home currently has 5 residents, with 1 resident on hospice. Administrator (AD) Chin-Wen Cheng arrived shortly to assist. AD has a valid certificate that expires on 9/16/2025. AD provided updated liability insurance that expires on 2/22/2026.

LPA along with staff 1 (S1) toured the facility at 8:35 AM. LPA toured the physical plant, checked food service, facility documentation and the first aid kit. The home consists of 5 resident bedrooms, living room, dining room, staff room, staff bathroom, 2 resident bathrooms, and kitchen. At 8:38am, LPA observed 1 out of 5 stove burners to be non-operational. LPA observed sharps locked in a kitchen cabinet during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 105.2 degrees F and 112.6 degrees F in all bathtrooms check. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPAs reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts quarterly emergency drills with the last drill conducted on 12/10/2024. Continued on LIC809C dated 3/27/2025.