Facility Evaluation Report

On October 9, 2025, LPA Manuel Monter and Marcella Tarin conducted a POC visit. LPAs met with Administrator / Licensee Xi-Hua Luo (ADM1). LPAs explained the purpose of the visit.

On October 2, 2025, the facility was issued the following Type A Deficiencies with a POC date of October 3, 2025. As of today’s visit, the licensee has not submitted or corrected citations resulting in civil penalties.

The following deficiencies were cited during a complaint investigation visit/ case management deficiencies visit conducted on October 2, 2025, and are as follows:

• 87468.1 Personal Rights of Residents in All Facilities (a) - Type A, issued initial Civil Penalty (CP) of $500.00 beginning October 4, 2025, and will continue to accrue until corrected.

• 87202 Fire Clearance (a) -Type A, Issued initial CP of $500.00 beginning October 4, 2025, and will continue to accrue until corrected.

• 87755 Inspection Authority of the Licensing Agency (a) - Type A, Issued initial CP of $500.00 beginning October 4, 2025 and will continue to accrue until corrected.

Civil Penalties issued today for the maximum of $1500, for failure to correct. LPAs informed ADM that if the 3 deficiencies are not corrected, civil penalty will continue to accrue until corrected. LPA discussed about the importance of Plan of Correction. ADM agreed and understood.