Pre-licensing visit·May 22, 2023

Licensing Program Analyst (LPA) Yolanda Delgado conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. At approximately 9:00 AM, LPA met with Licensee/Administrator Ma Satchel Lecita and Long Zhang, Licensee. An Initial Application to operate a Residential Care for the Elderly facility (RCFE) was submitted to the Central Applications Bureau (CAB) on 1/22/23 for a total capacity of twelve (12); (5) non-ambulatory and seven (7) ambulatory residents. Fire clearance was granted on 04/17/2023. LPA Delgado observed the following: Structure: Facility was a one-story house with seven (7) resident bedrooms, three (3) resident bathrooms, living room, dining area and kitchen. There was an attached three (3) car garage in the front of the house with recently added wood beam structure to separate a part of the garage into storage rooms. Heating/Cooling System: Central heating and air conditioning system installed with two panels located in the reception area and hallway to control entire house. Bedrooms: Each resident bedroom #A, #C (shared) and #G (shared) will accommodate any non-ambulatory resident, bedrooms #B, #D (shared), #E (shared), and #F (shared) will accommodate ambulatory residents. Seven (7) resident bedrooms were adequately furnished with bed, some bedrooms missing chairs, closet, appropriate linens, adequate lighting, and an operable smoke alarm. Bathrooms: Three (3) resident bathrooms has a working toilet; toilet in #G not flushing, wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. At 10:01 AM, LPA tested the water temperatures in the resident bathrooms; room #G shower faucet is loose from wall. LPA verified water temperature was measured at 105.3 degrees Fahrenheit. (CONTINUED ON LIC 809C) (CONTINUED FROM LIC 809) Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots and pans were observed. Knives/sharp instruments were secured in a locked drawer located in the kitchen. There was adequate room for food storage. Several cabinets with food stored had locks and a white plastic chain that blocked access to food supply. LPA observed the stove to be operational. Refrigerator/freezer were in working condition and had sufficient storage for perishable food. There was adequate seating for meals for all clients. Laundry room with washer and dryer was located inside the house. Laundry detergents and cleaning supplies were observed inside laundry room away from residents. Living/Dining room: There was a living room with furniture and TV and Dining room with furniture for all clients. Linens and Hygiene Supplies: An adequate supply of linens was stored in a cabinet in the main hallway of the residence and Room #G that extra linen will be relocate to the Laundry room. Yards/Outside: Patio furniture and sufficient chairs were observed in the backyard. There was a gate on the South side of the property with a self-latching lock. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch were observed posted in the main hallway; needs to be updated to reflect the changes in the garage. Obudsman poster and Let-Us-No poster observed. General items: Six (6) fire extinguishers were charged; however missing inspection tags and/or receipts when purchased and located in the kitchen, (3) reception, and (2) hallway . Twelve (12) smoke alarms and two (2) carbon monoxide detectors were tested and were observed to be in working order. Windows were missing screens and/or had torn screens. Client records will be stored in a locked cabinet in the Reception area. First Aid kit with required components; no First Aid Manual observed, and locked area for medication storage was observed. LPA observed a facility phone and it was verified to be operational as evidenced by LPA dialing the number to trigger a ring. Emergency water supply was observed however the required 72-hour emergency food supply was not discernible from the regular food supply. (CONTINUED ON LIC 809C) (CONTINUED FROM LIC809C) Pre-Licensing is incomplete and the following corrections to be resolved by 5/31/2023: obtain a separate 72-hour emergency food supply obtain screens for windows obtain chairs for resident rooms obtain a label and post for Hot water 125 degrees for kitchen sink obtain receipts or service tags for all fire extinguishers obtain a hard surface for bed frames obtain Firs Aid Manual latest edition obtain paper towel holders or dispensers for paper towels obtain and post visiting policy consult pest control for insects relocate linen from Bathroom #G repair toilet for Room #G to be able to flush repair shower faucet; loose from wall replace torn window screens remove white plastic chain in kitchen remove latches and locks for all kitchen cabinet doors except sharps and cleaning products Kitchen needs deep cleaning for dirt buildup Bathrooms needs deep cleaning for dirt buildup Updated Facility sketch with CAB An exit interview was conducted, and a copy of this report will be emailed and a receipt of confirmation will be requested.