Routine inspection·September 24, 2023

On 9/24/2023 at 1:30pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced 1-Year Required inspection. LPA met with Reggielyn Daigdigan, Caregiver, and explained the purpose of the visit. Kevin Li, Administrator arrived at 1:50pm. The Administrator currently holds a certificate (#6040792740) that expires on 07/26/2024. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of four (5) total bedrooms, which one (1) bedroom is occupied by staff, and two (2) bathrooms. No bodies of water observed. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 133.1 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 04/27/2023. Emergency Disaster Plan was last posted on 5/17/2018. First aid kit was observed to be complete. LPA reviewed three (3) staff files and all did not have current first aid certification. Continued on LIC809C. Continued from LIC809. LPA reviewed all six (6) resident files and three (3) of six (6) did not have a current appraisal needs and services plan. LPA observed the following deficiencies: At 1:35pm, LPA observed S3 was not associated to the facility. At 1:40pm, LPA observed flip door lock at top of front door. At 1:50pm, LPA observed hot water in shared bathroom measuring at 133.1 degrees F. At 1:55pm, LPA observed that R2, R3, R4, and R5 did not have a doctor's order for bedrails. At 2:15pm, LPA observed during record review R2, R3, and R5 did not have a current appraisal needs and services plan. At 2:30pm, LPA observed a pile of cardboard boxes, a fan, a sink, chairs, a night stand, wheelchairs, walkers, a lamp and other items in back yard. At 2:35pm, LPA observed shed in back yard being used as a living quarters. At 3:00pm, LPA observed during record review that none of the staff have first aid or CPR certification. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of appeal rights and this report provided.