Facility Evaluation Report

Licensing Program Analysts (LPAs) Steve Chang and Manuel Monter conducted an unannounced case management visit and met with administrator (ADM) Xiuyan Chen. LPAs observed 3 residents and 1 staff in the facility.

Based on record review of the facility file, ADM’s ARF Administrator's Certificate expired on 04/18/2024. There was no valid copy of ADM’s ARF Administrator’s Certificate found on the facility, nor ADM submitted a copy to CCL.

During today’s inspection visit, ADM stated that she completed the required training for the ARF Administrator’s Certificate herein it was submitted to CCLD Certification Unit on 03/27/2024. LPAs requested copies of completed required training to ADM, but she was unable to provide the evidence of training and hours completed. ADM’s name on the CCLD pending list of ADM renewals, is not on the list as of 5/15/24.

LPAs observed only 1 staff (S1) during visit. LPA verified S1 has a current fingerprint clearance, but he/she is not associated to the facility through Guardian and/or LIS. S1 stated began his/her employment since April 7, 2024. S1 works Tuesday -Saturday, as a live in staff. ADM admitted that she did not associate S1 to the facility personnel roster. As a result, deficiency is being cited per California Code of Regulations, Title 22. See LIC809-D. A civil penalty is being assessed for $500 ($100 per day x 5 days = $500) for S1 working in the facility without association.