Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced Case Management - Legal/Non-compliance inspection visit and met with Administrator (ADM) Xiuyan Chen.

The purpose of the visit is to ensure that facility is adhering to the Compliance Plan submitted to Community Care Licensing (CCL) after a Non-Compliance Conference held on 03/28/23. The case management of inspections will be conducted every 3 months for 2 years. LPA observed 1 residents (R1) and 2 staff (S1, S2) in the facility.

LPA toured the facility with ADM. LPA checked the Garage and found the garage was empty. LPA checked the two extra rooms in the backyard, and both rooms were used as storage rooms. Knives closet, medications closet and detergent closet under the sink in kitchen were observed locked. Supplies of drinking water, two days perishable food supplies and seven days nonperishable food supplies were observed sufficient. No chemical were observed in the cabinet with food supplies. LPA checked residents' physician reports, Appraisal Needs and Service Plans and Centrally stored medications log. The documents are up to date except resident R1's appraisal needs and service plan.

LPA checked ADM's Administrator Certificate and it is valid. LPA observed 2 resident rooms and 1 staff live-in room. LPA observed a partition in the living room which is for staff break.

LPA discussed with ADM regarding that the facility to provide the training to staff regularly, to ensure adequate staff necessary for residents' care and supervision, and updating facility's emergency plan.