Facility Evaluation Report

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required inspection – 1 yr. Infection Control inspection met with staff, Dongmei Graves. Licensee/Administrator Jun Ji Zheng arrived later.

LPA arrived at the facility and had their temperature checked and logged into a sign-in sheet. LPA observed that staff were wearing masks during this visit. LPA/staff conducted a walk-through of the facility and observed Covid-19 posters that included hand washing signs in restrooms. Hand sanitizer are located through the facility. Facility has a bathroom that is kept stocked with hand hygiene products. Commonly touched surfaces are disinfected at least once a day. Facility has designated an outdoor area for visitation. Facility staff have been trained on PPE protocols, but have not yet been N-95 fit tested. Staff and residents are being monitored daily and facility does document daily screening results in a binder. Facility maintains a 30 day supply of medication. Facility has a 100% vaccination rate of staff and residents. Clients do attend to Day program in average of two days per week. Facility has games and other activities for client use during off days. Clients do not typically wear a mask while in the facility, but they do wear masks when in the community. Facility has more than a 30 day supply of Personal Protective Equipment (PPE) including masks, face shields, gowns and hand sanitizer. Facility has submitted their Covid Mitigation Plan, it was approved on 3/12/21 and submitted their Infection Control Plan for review. At approximate 1:38pm LPA/Administrator observed two out of two fire extinguisher was last serviced on July, 2021.

Licensee provided updates for the following documents: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500), Emergency Disaster Plan (LIC610E). Cash Affidavit for client cash resources (LIC400) and Surety Bond.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.