Facility Evaluation Report

On December 30, 2024, at 11:40 AM, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. LPA met with the Administrator, Mark Sung and disclosed the purpose of the inspection. The administrator informed the LPA that the facility currently has (3) staff members and (5) residents in care, 4i level, and all 5 are ambulatory. (3) residents were away at their day program, (1) resident was sick at facility and (1) resident was visiting family.

LPA initiated a walk-through of the facility, accompanied by the administrator.

LPA inspected the kitchen and found it clean, with no food preparation or cooking in progress at the time. LPA checked the appliances and observed them in working order. LPA observed a locked cabinet under the sink with knives, sharp objects, soap, and cleaning supplies, inaccessible to the residents. LPA inspected the refrigerator and pantry cabinets and observed enough supplies of fresh perishable food for (2) days and nonperishable staples for (7) days. A lockbox containing Insulin medicine was observed. No expired food was noticed.

LPA inspected the dining area and observed it clean, with all the furniture in good repair. There was a dining table and enough chairs to accommodate all the residents. LPA inspected the common room and observed sofa, chair, TV, computer stations, games, board games, puzzles, and activities items for the residents. LPA inspected the fire extinguisher mounted on the wall in the hallway and found it was fully charged with a last service tag of 03/07/2024. The administrator tested the smoke and carbon monoxide detector located in the hallway in the LPA's presence, and it was found to be functional. Additional smoke and carbon monoxide detectors were observed in all bedrooms and common areas of the facility during the visit.

There are (4) bedrooms and (1) bathroom designated for residents' use. (3) resident bedrooms were private and (1) resident bedroom was shared occupancy. LPA inspected all (4) resident rooms and found them clean, well-lit, and equipped with the required furniture.