Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit and met with Administrator Xi-Hua Luo. During the visit, LPA observed 6 residents and 3 staff. LPA explained the purpose of the visit was to conduct the annual inspection, continue the complaint investigation for the complaint 26-AS-20250115102820 and follow up on an incident report regarding an elopement.

LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 5 restrooms and 6 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. While touring the side of the facility, adjacent to the kitchen/ family room, LPA observed the side gate had a lock, obstructing the side exit. (Photograph of the lock gate was taken.) ADM stated the gate is locked because resident R1 has wandering behaviors.

Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 79 degrees F, and hot water temperature was measured at 106.7 degrees F to 113 degrees F in resident bathrooms.

Fire extinguisher was serviced in July 2025. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on 8/26/2025. . LPA reviewed 3 resident medications and centrally stored medication records. LPA reviewed facility records for 3 staff and 3 residents. Based on a review, resident R1's needs and services plan has not been updated, and does not address R1's wandering behavior. Page 1 Out of 3.