Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit and met with Administrator/Licensee (ADM) Xiuyan Chen. LPAs observed 4 residents and 1 staff in the facility. LPA reviewed 2 resident files and 2 staff files.

LPA toured the facility inside and out with ADM. License and valid Administrator Certificate were observed at the main entrance. LPA did not observe personal rights posters posted in the facility. LPA toured living room, kitchen, dining area, restrooms, laundry area. The facility has 3 bedrooms and 2 restrooms. An office was observed in the garage. Medication closet, knives closet, and cleaning product closet were observed locked. Non-skid mat was not observed in one of the two restrooms. ADM bought a new non-skid mat and put in the restroom before LPA finished the inspection. Room temperature was observed at 80 degree F, and hot water temperature was observed at 119 degree F. Refrigerator temperature was measured at 37 degree F, and freezer temperature was measured at 0 degree F. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient.

The facility is equipped with fire alarm and smoke and carbon monoxide detectors. ADM tested the smoke and carbon monoxide detectors, and they were working fine. The fire extinguishers were observed on service on 9/19/2023. ADM asked the fire extinguisher service company to send staff to service on site before LPA finished the inspection. LPA inspected the backyard, there was no obstruction to block the walkway. Two storage rooms and one restroom were observed in the backyard. No obstruction blocked the walkway to the exit gate. First aid box was observed in the facility. LPA did not see flash lights and night light in the facility. ADM bought flash lights and night lights before LPA finished the inspection. The last time the facility conducted fire drill was on 4/24/2024.

Deficiencies noted today. See LIC809-D. Exit interview was conducted with ADM. The report was provided to ADM for signature. A copy of the reports were provided to ADM.