Facility Evaluation Report

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced case management - deficiencies visit and to amend the annual required inspection that was conducted on July 31, 2024. LPA met with licensee/administrator (LIC/ADM) TingXiu Li and stated the purpose of the visit.

LPAs toured the facility inside and out including 4 resident bedrooms, two restrooms, kitchen, living room, dinning room, and backyard. LPA observed 3 of 3 residents were in their bedroom resting. LPA observed no toxic, chemicals or knives during today's visit that are accessible to residents. The screen door in the sun room was repaired and working properly.

LPA toured the kitchen and pantry closet to observed 2 days of perishable foods and 7 days of nonperishable foods. LPA observed no obstructions on the walkways and hallways, exits were free from obstruction. Alcoholic beverages were in a locked container and all medications are in a locked cabinet.

LPA reviewed the Centrally Stored Medication and Destruction Record (CSMDR) and observed that list of medication are listed on the CSMDR. LPA reviewed the appraisal needs and services plan (LIC 625) of 2 of 2 residents and observed that it was completed by LIC/ADM .

LPA amended a repeat violation that was assessed incorrectly on 7/31/2024.

No deficiency was cited during today's visit based on California Code of Regulations (CCR) Title 22. An exit interview was conducted with LIC/ADM TingXiu Li. A copy of today's report, amended citation and appeal's right was provided to the licensee.