Facility Evaluation Report
Licensing Program Analysts (LPAs) Steve Chang and Manuel Monter 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. LPAs observed 3 residents and 1 staff in the facility.
LPAs toured the facility with ADM. LPAs checked the Garage and found the garage was empty. LPAs 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. LPAs checked residents' physician reports, Appraisal Needs and Service Plans and Centrally stored medications log.
LPAs checked ADM's Administrator Certificate and it is valid. LPA observed 3 bedrooms and 2 restrooms in the facility LPA observed a partition in the living room which is for staff breaks. 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. LPA discussed with ADM regarding the personal rights, sufficient food supplies and to maintain resident files and staff files accurately and up to date. LPA discussed with ADM regarding to maintain the Administrator Certificate up to date. The valid time period of the Administrator Certificate is 4/19/2024 - 4/18/26. Room temperature was measured at 82 degree degree F, and hot water was measured at 118 degree F.
Exit interview was conducted with ADM. The report was provided to ADM for signature. A copy of the report was provided to ADM.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction