Facility Evaluation Report

On October 28, 2025, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced annual inspections. LPA met with Caregiver, Hongyi (Jack) Liang and explained the purpose of the visit. Administrator, Shengxi (Simon) Liu joined shortly thereafter.

LPA toured the facility inside and outside including all of resident rooms, common areas & kitchen. The indoor and outdoor passageway was free of obstruction. No accessible bodies of water of fire safety hazards observed. This is a single story facility. There are three resident rooms, all of which were observed to be shared rooms. Resident rooms were observed with all required furniture. LPA observed Resident 1 (R1's) bed to have a full bed rail. Administrator indicated R1 is not on hospice. Two full bathrooms were observed to be odor-free and in good repair. Water temperature throughout the facility measured between 127-131 degrees F. Extra linen was observed to be present.

Dining room was observed free from tripping hazards. A comfortable temperature of 71 degrees F is maintained and lighting is sufficient for comfort. LPA observed two day perishables and seven day non-perishables. Extra food supply was observed to be present. Sharps and chemicals were observed to be locked and inaccessible to residents. LPA observed R1's prescribed insulin unlocked and accessible in the refrigerator.

Carbon monoxide monitors are working properly. All fire extinguishers have been checked and are observed charged. LPA reviewed 6 resident records and 4 staff records. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC809D. Failure to correct the deficiencies may result in civil penalties.

Report is reviewed with the administrator, and a copy is provided with appeal rights