Facility Evaluation Report

On 7/31/2024 at 9:35 a.m. Licensing Program Analysts (LPA) Maria (Mita) Partoza and Manuel Monter arrived and conducted an unannounced required 1 year inspection visit. LPA was greeted by the staff (S1). Licensee/Administrator Tingxiu Li, was not in the facility but arrived at the facility within 10 minutes.

The facility is a Residential Care Facility for the Elderly (RCFE) licensed to serve ages 60 and over 6 non-ambulatory, and a waiver for 2 hospice care. The facility's has 2 residents (R1 to R2) that have neurocognitive impairment. 1 staff were present at the time of the visit. 2 residents were present at the facility and 1 of 2 was in the living room area. LPA observed 1 of 2 residents is in the bedroom and 2 of 2 residents are under hospice care.

At 9:40 a.m. LPA toured the facility inside and outside with ADM, including but not limited to the kitchen, bathroom, dining room, living room, residents rooms, staff room, backyard and walkways. LPA observed the Centralized Complaint and Information Bureau (CCIB) of the CA Department of Social Services (CDSS) on the cork board by the entry way printed on a 8 1/2 x 11 paper it is visible to visitors, resident and staff. The temperature inside the home was at 74 degrees F.

LPAs and ADM toured the 4 bedrooms and LPA observed the rooms to be organized and free from debris and has sufficient storage for resident's personal belongings. 1 of the 4 bedroom is shared. The bathroom inside the shared room is used by other residents. Resident's bedroom has a call alarm system to alert staff if assistance is needed.