Facility Evaluation Report

Licensing Program Analyst (LPAs) Steve Chang and Simi Rai conducted an unannounced inspection visit and met with Administrator (ADM) Xiuyan Chen. LPA addressed the purpose of today's visit to ADM. Upon arrival, ADM took LPAs body temperature, and checked LPAs in the visitor log book.

LPAs interviewed ADM. Two clients were observed in facility.

LPAs toured the facility inside out with ADM. Screening station with masks, hand sanitizer, glove, thermometer and visitor log book was observed at the main entrance. Living room, kitchen, dinning room and two restrooms were inspected. All trash cans were observed with covers. Paper towels were observed with holders. Cloth towels were observed in the kitchen and restrooms. Three resident bedrooms, and laundry room were inspected. Two ADM's private use bedrooms were observed outside the facility. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, knives closet, were observed locked. Cleaning product closet were observed not locked. ADM stated ADM will put the lock on the cleaning product closet. Hot water temperature was at 108 degree F in facility.

Fire extinguisher was serviced on 09/16/2022. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways.

ADM stated all the residents and staff are fully vaccinated. ADM will send the Infection Control Plan to LPAs.

No citation were noted today. Exit interview was conducted with ADM. This report was provided to ADM for signature.