The facility has an approved fire clearance for (6) non-ambulatory residents. The facility is a single-story building with 6 bedrooms, 3½ bathrooms, a living room, laundry area, and a garage.

At 9:24 AM, the LPA initiated a walk-through of the facility, accompanied by the Administrator.

LPA inspected the kitchen and found it in good repair. The appliances were checked and observed to be in working order. The LPA observed a locked cabinet containing knives and sharp objects, and a locked cabinet under the sink with detergents, disinfectants, and cleaning supplies. The refrigerator and freezer were inspected and observed to be in working condition. The Administrator stated they will be storing resident’s medications in a locked cabinet in the kitchen.

LPA inspected the dining area adjacent to the kitchen and found it clean. Dining table and chairs were in good repair.

LPA inspected the living area. LPA observed a TV placed on a glass top and two pedestal stands, which were not sturdy. LPA inspected the fire extinguisher mounted on the wall in the living room and found it fully charged, with the purchase tag dated 10/13/2024.

There were (6) bedrooms and (3½) bathrooms designated for residents' use. LPA inspected all (6) private resident rooms. There was no furniture in five (5) bedrooms. LPA observed chipped paint on the walls and ceilings in the bedrooms. LPA inspected (3½) bathrooms and found them sanitary, and in good working condition. LPA observed the bathrooms didn’t contain soap, grab bars, paper towels, and trash cans. The hot water temperature at the sink faucet in all bathrooms measured between the range of 115.2°F to 118.8°F.

Continued on LIC809-C

The Administrator tested the smoke and carbon monoxide detector located in the hallway in the LPA's presence, and it was found to be functional. Additional smoke and carbon monoxide detectors were observed in all bedrooms and common areas of the facility during the visit.

LPA toured the backyard area and found ramps and passageways in good condition and clear of obstructions. No bodies of water were noted. LPA observed tripping hazards on one of the side yards. There was no outdoor patio furniture for resident’s use.

LPA inspected the first aid kit and observed it was missing scissors and tweezers.

Following issues needs to be addressed prior to the licensure -

• Clean blinds and shades throughout the facility
• Beds, mattresses, bedsheets, pillows in all residents’ rooms
• Chair, night stand, and chest of drawers in all residents’ rooms
• Grab bars in shower and toilet in the bathrooms
• Paper towels, soap, and trash cans in bathrooms
• TV stand in the living room
• Scissors and tweezers in the first aid kit
• Add gate or side yard fence door
• Set of a backyard patio table, chairs, and umbrella
• Fix walls and ceiling paint chip offs and scratches throughout the facility
• Setup the house in move in condition for the residents

An exit interview was conducted with the Administrator. A copy of this report was left with the Administrator, Ying Wang, whose signature on this form confirms receipt of the report.