Facility Evaluation Report

On 1/30/2025 at 08:50 a.m. Licensing Program Analyst (LPA) Steve Chang conducted an unannounced Case Management for Legal/Non-compliance inspection visit. LPA met with Administrator Xiuyan Chen. LPA observed 2 residents in the facility.

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. The case management of inspections will be conducted every 3 months for 2 years

LPAs toured the facility inside and out including kitchen, dining room, living room, bathrooms, residents rooms, storage room, garage and exterior perimeters. LPA checked the two extra rooms in the backyard, and both rooms were used as storage rooms. The garage was observed as storage room. 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. The documents are up to date. The water temperature was measured at 115 degree Fahrenheit. The fire extinguisher was serviced on 9/24/2024.

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.