Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Tingxiu Li. LPA toured the facility inside and out with ADM. License, Administrator Certificate, and personal rights posters were observed in the facility. 4 residents and 2 staff were observed in the facility. LPA reviewed 2 resident file and 2 staff files.

Family room, living room, kitchen, dining area, 2 restrooms, a office, and garage were inspected. 4 resident bedrooms were inspected. Two staff room was observed in the facility. 4 beds with bed rails were observed in the residents rooms. ADM stated the residents have the document for bed rails. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. The temperature of the freezer was observed at 0 degree F, and the temperature of the refrigerator was observed at 37 degree F. Medication closet, knives closet, and chemical closet were observed locked. Room temperature was at 76 degree F, and hot water temperature was at 107 degree F in facility. Fire extinguisher was serviced on 5/20/2025. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Carbon monoxide detectors were tested by ADM, and were working. First aid box, night lights, and flash lights were observed in the facility.

Front yard and backyard were inspected. There was no obstruction to block the walkways. A storage room was observed at backyard. The last time the facility conducted the emergency and fire drill was on 6/1/2025.

Deficiency noted today. See LIC809-D. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of the report was provided to ADM.