Facility Evaluation Report

Announced Prelicensing visit made out to this facility on 02/10/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility Applicant, Susan Xiong, and her sister, Yer Xiong, at this time. A brief interview was conducted with the facility Applicant and her sister at this time.

It was learned that this applicant is also seeking vendorization through Valley Mountain Regional Center (VMRC) to be able to accept and retain up to (4) Level 4I residents at any given time.

A tour of the facility kitchen area was conducted. Kitchen drawers and cabinets were reviewed. It was observed that there was a sufficient supply of plates, cups, and other dinnerware/flatware made available to meet the needs of the residents at this time.

Knives and other sharp objects were observed to be stored in a manner that was locked and made inaccessible to the residents at this time.

A review of the facility 2-day perishable and 7-day nonperishable food quantities was conducted and observed to be sufficient and able to meet the needs of the residents at this time.

Pantry closet was toured. First aid kit was observed to be stored in this location at this time. All required components for the first aid were observed to be present and in compliance at this time.

Sample copies of the facility resident files were observed to be present at this time.

Sample copies of the facility staff files were observed to be present at this time.

A review of the facility Medication Administration Record was conducted at this time.

A tour of the dining area, living area, and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time.

Fire extinguisher, located in the kitchen area, was observed to have been annually inspected by the local fire extinguisher company, Armor Fire, on 07/01/2024 and in compliance at this time.

A tour of the resident bedrooms (4) was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time.

A tour of the resident restrooms (2) was conducted. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees at all times.