Facility Evaluation Report

Licensing Program Analysts (LPAs) Steve Chang and Ryker Heberle conducted an unannounced Case Management - deficiency inspection visit, and met with staff Jisselle Penales (S1) and Administrator (ADM) Xiuyen Chen.

LPAs toured the facility inside an out with S1. Bleach was observed to be accessible in facility bathroom underneath the sink. LPAs also observed engine coolant and power steering fluid underneath the sink in additional bathroom. 2 facility rooms observed to have foul odor. Cleaning supplies observed to be stored in medication cabinet. ADM moved all cleaning supplies to spare room room away from facility medication. Medication closet and knives closet were observed locked. 2 days perishable food supplies and 7 day nonperishable food supplies were observed not sufficient. Gardening supplies observed available to residents. ADM stated she was in the process of leaving to go grocery shopping, but LPAs arrived as she was leaving. ADM stated she will go grocery shopping later. Fire extinguisher was serviced on 9/16/2022.

S1 stated she was sent by agency to provide care and supervision, and the working schedule is from 7:00AM - 7:00PM for today. LPAs observed S1 cooked and provided the food to residents.

LPAs wanted to access the extra 2 bedrooms, S1 stated she does not have the keys. ADM stated the residents in the 2 extra rooms moved out last night (3/3/2023). ADM opened one of the extra rooms for LPA, but ADM did not have the key for the other extra room since the previous resident did not return the key yet. ADM conformed both residents moved out already.

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