Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Tingxiu Li. LPA toured the facility inside and out with ADM. License, Administrator Certificate, and personal rights posters were observed in the facility. 3 residents and 1 staff were observed in the facility. LPA reviewed 2 resident file and 1 staff files.

Living room, kitchen, dining area, 2 restrooms, and garage were inspected. LPA observed a bed in garage, ADM stated the bed will be removed this week. 4 resident bedrooms and a staff room were inspected. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. The temperature of the freezer was observed at -1 degree F, and the temperature of the refrigerator was observed at 37 degree F. Medication closet, knives closet, and chemical closet were observed locked. Room temperature was at 78 degree F, and hot water temperature was at 116 degree F in facility. Fire extinguisher was serviced on 6/24/2025. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Carbon monoxide detectors were tested by ADM, and were working. First aid box, night lights, and flash lights were observed in the facility.

Front yard and backyard were inspected. The branches of a tree was observed hanging out but people still can walk through to the exit gate. ADM stated the facility will trim the branches by end of this week. A pond was observed closed in the front yard. A storage room was observed at backyard. The last time the facility conducted the emergency and fire drill was on 6/1/2025.

Deficiency noted today. See LIC809-D. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of the report was provided to ADM.