Pre-licensing visit·April 8, 2025

Licensing Program Analyst (LPA) Jenifer Tirre visited this facility for the purpose of conducting a Pre-Licensing evaluation. Facility is a two story residential home with attached garage. LPA along with Licensee’s/ Administrators Chin Wen Cheng and Tsung Shun Yu toured facility at 1:00 PM and observed the following: Fire clearance approval was received on 01/15/25. Structure: Facility is a two story, 2 resident bedrooms (1 private room & 1 shared room), one staff room and 2 bathroom house with attached garage. Second floor will be occupied by Licensee and no residents will reside upstairs. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Fire places have proper covers Bedrooms Residents: All Residents bedrooms are equipped with appropriate bed, lighting, chair, night stand and ample closet space. Bathrooms: All resident bathrooms have a working toilet, wash basin, and bathtub/shower as well as grab bars and non-skid surface in the shower. Linens & Hygiene Supplies: Facility has adequate supply of linens and towels. Emergency Phone Numbers and Exit Plan: Facility has Emergency Plan posted on wall. Food Service: Facility has 2 day perishables as well as 7 day non-perishables in the pantry/ refrigerator, as well as emergency food and water supply. Smoke Detectors: Smoke detectors/ carbon monoxide detector are Bluetooth wired and were tested operational. Fire extinguisher is mounted and fully charged. Facility has one extinguisher. Appliances: Gas Stove and refrigerator are operational. Toxins : LPA observed toxins secured in storage area.. Water Temperature: Tested and recorded at 111.0 degrees F. in facility bathrooms. CONTINUED ON 809C CONTINUED... Reading Material Games, and Equipment: facility has puzzles, books and music therapy available for residents. Medications, First-Aid Kit & Book: Facility has first aid kit with manual present at the facility. Facility has a secured location for sharps, medications and facility files. Backyard: LPA observed the facility perimeter is secured by wall with a self latching gate on both sides of facility as required. LPA observed shaded outside area. Fire Clearance: Approved for one ambulatory and two non-ambulatory residents. LPA observed emergency lighting. Licensee to address the following corrections by 4/15/2025 · Let us Know Poster is not regulation size, please have proper size poster 20x26 posted near entrance · Audible alarms placed at exists · Call signal buttons for resident rooms · Backyard patio seating for shaded area The facility is not ready to be licensed. Licensee to contact LPA when corrections are complete. Component III was conducted and reviewed during visit. An exit interview was conducted with Licensee's Yu and Cheng. A copy of this report was provided to the facility.