Routine inspection·July 18, 2024

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Alan Tuan. 12 residents and 4 staff were observed in the facility. License, an expired Administrator Certificate, and personal rights posters were observed in the facility. ADM provided the documents that he/she renewed the Administrator Certificate already. LPA reviewed 6 resident files and 4 staff files. One resident file was observed without Appraisal/Needs and Service form. 2 resident files were observed the centrally stored medication forms were not updated and not matching with the medications. LPA toured the facility inside out with ADM. 15 resident single rooms, 1 staff live-in room, 1 office, 1 storage room, living room, dining room, two common restrooms and kitchen were inspected. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication room was observed locked. Knives closet was observed unlocked, ADM locked the knives closet immediately. Cleaning product closet were observed unlocked. ADM put an lock and locked the cleaning product closet before LPA finished the inspection. Room temperature was at 76 degree F, and hot water temperature was at 118 degree F in facility. Emergency light system, first aid box, night lights, and flash lights were observed at the facility. ADM and LPA tested the signal system, and it works fine. The last time the facility conducted the emergency drill is 7/10/2024. Continue on LIC809-C. Page 1 of 2. Fire extinguisher was serviced on 7/10/2024. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and it was working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways. One storage room was observed at the backyard. Deficiency was 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. Page 2 of 2.