Facility Evaluation Report

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced continuation of the annual visit and met with Lead Staff, Irish Samantha Sinio. LPA Rai spoke with Licensee (LIC) Cindy Chen and Administrator (ADM) Donna Lagman and stated the purpose of today's visit. Both LIC and ADM informed LPA Rai over the phone they will not be present at the facility during todays visit. LPA Rai observed 4 staff, including Lead Staff and 4 residents at the facility.

During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai observed three locked storage unit which was used as storage and not habitual space. LPA Rai observed the laundry machine in the backyard and observed 2 laundry detergents and 5 gallons of paint unlocked and accessible to the residents Lead Staff removed the items and locked them in one of the storage units. LPA Rai observed 1 resident smoking in the backyard who has neurocognitive disorder and was not supervised. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies.

LPA Rai toured 6 bedrooms, out of which 4 bedrooms are occupied by residents and 2 bedrooms are occupied by staff. The resident bedrooms had available bedding, drawers, and functioning lights. LPA Rai observed 2 out of 4 resident had half-bed rails attached to the resident's bed. Lead Staff stated the residents do not have signed written physician's order for residents to use half-bed rails for mobility. Lead Staff confirmed the 2 residents are not under Hospice or Home Health services.

LPA Rai toured the garage and observed a sofa with blankets and rack of cloths hanging over the soda. Lead Staff states the bed is for lounging for staff and the garage is not used as a bedroom for any person.