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.

S1 stated she works from 7:00AM - 7:00PM today to provide care and supervision to residents. LPAs toured the facility inside an out with S1. 2 day perishable food supplies and 7 days nonperishable food supplies were observed to be sufficient. Detergent closet, medication closet and knives closet were observed locked.

S1 tested the facility alarm system, and it worked fine. LPAs toured 2 restrooms and 3 bedrooms. 5 residents were observed in facility. S1 does not have the key for the 2 extra rooms to open for LPAs to inspect.

ADM showed the Administrator Certificate to LPAs. The certificate will expire in April 2023. LPAs suggested ADM to renew immediately.

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