Facility Evaluation Report

On 07/18/2023, Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct an annual inspection visit. Upon LPAs arrival, Caregiver Mei Chen was present at facility and contacted Administrator Ray Gin who arrived a bit later. LPA met with Administrator Raymond Gin and explained the purpose of the visit.

Administrator holds certification # 6004232740 and is expired on 7/5/2023. Renewal application is currently pending. The facility is licensed for 6 non-ambulatory residents. Hospice waiver approved for 2. There are (5) residents in care currently.

LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents in care. LPA observed required furniture and lighting throughout the facility. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises.

The hot water temperature was measured at 114.5*F which was within the required range of 105-120*F. The temperature inside the facility measured at 77*F which was within the required range of 68-85*F.

LPA observed the centrally stored medications area to be locked and inaccessible to residents. LPA observed the fire extinguisher(s) and first aid kits were up to date. LPA observed smoke and carbon monoxide detector(s) in the facility were in good repair. Proof of current liability insurance was observed. A full Care Tool Inspection was completed at facility.