Routine inspection·June 29, 2024

At 10:30 a.m. on this day, June 29, 2024, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with Rachel Estares Maniaul , assistant administrator, and informed the reason for visit. LPA called and spoke over the phone with Wendy Wong, licensee. Licensee arrived at 10:46 a.m, and Lulin Wu, administrator, arrived at 2:45 p.m. Facility has LIC9282 Infection Control Plan that was submitted and received by LPA on June 28, 2022. LPA toured the facility inside out with the assistant administrator, and joined by licensee. LPA inspected the kitchen, dining room, living room, reception area, shower room, ensuite bathrooms/toilets, front, side and backyards. LPA randomly selected 8 residents rooms for inspection. Shower room was observed equipped with bathing chair, non-skid mat and grab bars. Toilets were also observed with grab bars, paper towel in dispensers for drying hands and toiletries. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications and storages for cleaning supplies were observed locked. Facility has smoke and carbon monoxide detectors in operating condition. Hot water temperature in one of the ensuite toilets was tested. Facility conducts drills every quarter, and records showed last conducted June 4, 2024. Fire extinguishers were observed fully charge with tags showed serviced February 26, 2024. LPA reviewed 5 staff and 5 residents files, and interviewed 3 staff and 3 residents. Facility handles 6 of residents' P&I/allowance according to the assistant administrator. P&I money checked and compared with last recorded balance. Medications checked and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Record. ...continued on 809C (page 2) Page 2 LPA observed the following: -at 11:32 a.m., hot water in ensuite bathroom at 101.5 degrees Fahrenheit. -at 12:30 pm, resident (R1) LIC602A Physician's Report indicated bedridden. R1 can not reposition without assistance, and facility is not fire cleared/licensed for bedridden. LPA received the following updated/current documents on this day: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. LIC400 Affidavit Regarding Client/Resident Cash 5. Proof of Surety Bond Coverage 6. $3M Liability Insurance certificate Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. A $500.00 civil penalty is assessed for deficiency section # 87202(a)(2). Deficiencies and plan and proof of corrections were discussed with the licensee, administrator and assistant administrator. Exit interview conducted. Appeal Rights, LIC421IM Civil Penalty Assessement, LIC9098 Proof of Correction form and copy of this report provided.