Facility Evaluation Report

LPA Audrey Jeung toured facility and grounds of this one level RCFE. There are 15 private client bedrooms--12 of which have half bathrooms--dining, reading and living rooms, office, staff room, kitchen and 2 shower/bathrooms. A driveway and parking lot partially surround facility grounds; there is a patio with seating, and a detached storage unit in the rear. No accessible bodies of water or fire safety hazards are observed. Carbon monoxide detector is tested as operational. Washer and dryer are located on site. Each resident is issued a pendant alarm, which transmits an audible alert to staff in main hallway and staff room, that identifies the resident. Food supplies are adequate. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Hot water temperature tested at 111 degrees F in shower/bathroom. Soap and paper towels are present in bathrooms and kitchen sink. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is accessible. There is one resident receiving hospice services. Criminal record clearances or exemptions for facility staff or other individuals who have client contact are reviewed, as well as other staff and training records. Client records, including Centrally Stored Medications Records, are reviewed. Georgina Chavez is a certified RCFE administrator (x 10//27) that oversees facility operations with licensee Alan Tuan.

The following information/forms are requested to be updated and submitted to CCLD BY 8/12/26:

- Emergency Disaster Plan (LIC610E, including signature on 9th page)

Updated Personnel Report (LIC500) is provided to LPA today.

Deficiencies of the California Code of Regulations, Title 22, Division 6, are cited on following pages. Also see Technical Advisory Notes--2 pages--for additional information.