Facility Evaluation Report

Licensing Program Analyst (LPA) Rebecca Borunda conducted a plan of correction visit (POC). LPA was greeted by, identified herself to, and explained the purpose of the visit to Licensee Zayden Chen.

The purpose of the visit was to verify if the deficiencies issued on 9/22/2025, 9/25/2025, and 10/2/2025 have been corrected. The licensee was issued deficiency 87158(a) and 87411(f) with a correction due date of 10/3/2025 and deficiency 87415(a)(1) with a correction due date of 10/10/2025. On 10/2/2025, LPA Borunda provided a POC due date extension for regulation 87411(f) until 10/10/2025. As of today’s date, 10/16/2025, the licensee has not submitted POCs to the Department for deficiencies 87158(a), 87411(f), or 87415(a)(1).

During today’s visit, LPA Borunda verified that the licensee has not submitted an updated LIC200 and facility sketch requesting a fire clearance for two bedridden residents or a 30-day eviction for one of the bedridden residents to the Department. Therefore, deficiency 87158(a) has not been corrected. An immediate civil penalty of $100 per day totaling $1,400 is being assessed starting on 10/4/2025 for failure to correct and will continue to be assessed until corrected and is noted on the attached LIC421FC form.

LPA Borunda verified via record review that the licensee corrected deficiency 87411(f) regarding staff health screening and tuberculosis test and regulation 87415(a)(1) regarding staff schedule showing 24/7 staff coverage. Therefore, deficiencies 87411(f) and 87415(a)(1) have been corrected. LPA provided Licensee with Letters of Deficiency Cleared for both deficiencies.

An exit interview was conducted with Licensee Zayden Chen, whose signature below confirms receipt of a copy of this report, LIC421FC, Letters of Deficiency Cleared, and the Licensee Appeal Rights (LIC9058 3/22).