Facility Evaluation Report

On 10/20/2024 at 10:15 a.m. Licensing Program Analysts (LPAs) Steve Chang and Mita Partoza, conducted an unannounced Case Management for Legal/Non-compliance inspection visit and was greeted by staff (S1) Jacqueline Morales. Administrator Xiuyan Chen was not present at the time LPAs arrival. S1 stated that there are 3 residents and 1 staff currently at the facility. ADM arrived at the facility at 10:30 a.m.

The purpose of the visit is to ensure that the facility is adhering to the compliance plan submitted to Community Care Licensing (CCL) as agreed upon during the Non-Compliance meeting on 3/28/2023. Case management for Legal/Non-Compliance will be conducted every 3 months for 2 years.

LPAs toured the facility inside and outside and found such as the kitchen, dining, living room, residents rooms, storage room, garage and exterior perimeters. LPAs observed the facility to be sanitary and maintained. Residents room have sufficient storage, bathrooms are equipped with grab bars and non-skid mats. The Facility temperature measured at 70 degree Fahrenheit. The water temperature measured at 105.1 degree Fahrenheit. LPAs observed knives, sharps and medications are locked and not accessible to residents. LPAs observed 2 days of perishable food and 7 days non-perishable food.

The facility was maintained and kept organized. The facility cleaning supplies and chemicals were kept in a separate storage that is locked and not accessible to resident. LPAs reviewed the 3 residents records such as but not limited to Admission Agreement, Centrally Stored Medication and Destruction Record (CSMDR), Physician's report, Appraisal Needs and Services Plan, Personal Rights, and Consent forms. LPAs reviewed 1 staff record and observed record to be complete and updated.

No deficiencies were cited during today visit. An exit interview was conducted with administrator/licensee Xiuyan Chen. A copy of the report was provided.