Facility Evaluation Report

On 02/15/2024, Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the home in order to verify clearance of plans of correction created with Licensee, Sandy Zhao from visit on 01/22/2024. LPA Brown met with staff .

The following Plan of Correction (POC)s were not cleared at the time of the visit:

The Licensee was cited on 01/22/20224 for 87224 Eviction Procedures (a). Based on observation and interview, the Licensee refused to accept R1 back to the facility upon hospital discharge. Licensee did not submit the required plan of correction on the due date on 01/29/2024. Deficiency will be issued with new due date during this visit on 02/15/2024.

The Licensee was cited on 01/22/2024 for 87465 Incidental Medical and Dental Care (a)(6). Based on observation, interviews and records review, Licensee did not update R3, R4 and R5 Medication Administration Record (MAR) after dispensing R3, R4 and R5 medications per their physician's order. Licensee did not submit the required plan of correction on the due date on 01/23/2024. Deficiency will be issued with new due date during this visit on 02/15/2024.

The Licensee was cited on 01/22/2024 for 87309 Storage Space (a)(1). Based on observation, interview and records review, LIcensee did not lock the one (1) knife at the kitchen cabinet making it accessible to residents in care. Licensee did not submit the required plan of correction on the due date on 01/23/2024. Deficiency will be issued with new due date during this visit on 02/15/2024.

The Licensee was cited on 01/22/2024 for 87303 Maintenance and Operation (a). Based on observation and interview, Licensee did not have the kitchen cabinet and laundry cabinet in good repair. Licensee did not submit the required plan of correction on the due date on 01/29/2024. Deficiency will be issued with new due date during this visit on 02/15/2024. *** Continuation on LIC809C ***