Facility Evaluation Report

Licensing Program Analyst (LPA) Dang Nguyen made an unannounced visit to conduct a Required Annual Inspection. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensee/Administrator Zayden Chen.

According to the facility’s license, the facility has a maximum capacity for six (6) residents, of whom all may be non-ambulatory and one may be bedridden. Per LPA observation and manager interview: During today’s inspection, there were a total of zero (0) residents in care. The facility’s license does not include endorsements for delayed-egress doors or secured perimeter doors, and neither of these were present. LPA, accompanied by the Licensee/Administrator, toured the interior and exterior of the facility, and inspected all common areas and bedrooms. LPA also reviewed the Licensee/Administrator’s personnel file.

During the facility tour, LPA observed, and Licensee interview confirmed:

-The facility did not have working telephone, as required.

-The facility’s fire extinguisher had not been serviced within the last twelve (12) months, as required. [During today’s visit, Licensee phoned a professional vendor to make a service appointment for the extinguisher.]

-The facility required cleaning and/or repair in these areas: a) The facility’s doorbell annunciator/speaker was partially dismantled and was not working; b) The facility’s electric garage door (which is a potential emergency exit route per the facility sketch) was not working; c) An electrical outlet in Bedroom #4 was missing a receptacle; d) Two (2) of the electrical outlets in Bedroom #2 were missing plastic covers; [CONTINUED ON LIC 809-C]