Routine inspection·June 4, 2024

On 6/4/2024 at 9:30am, Licensing Program Analyst (LPA) Carol Fowler conducted an unannounced 1-Year Required inspection. LPA met with Fei Kevin Li, Administrator and explained the purpose of the visit. 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 (4) 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 69 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 120 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 6/04/2024. First aid kit was observed to be complete. LPA reviewed three (3) staff files and all three (3) resident files which were all complete. Continued on LIC809C. Continued from LIC809. LPA observed the following deficiencies: At 10:44am, LPA observed unlocked medication in staff bag located in the living room, and in room #3 in chest of drawers. At 10:46am, LPA observed Pine-Sol in 2nd bathroom on sink. At 10:56am, LPA observed freezer and refrigerator needs defrosting and cleaning. At 10:58am, LPA observed chair, sink, fan, box, walker 1/2 shovel, 2 ladders, night stand, mattresses, night stand, 2 lamps wheelchair, buckets, bookcase located in the back yard and open porch. Shed being used as living quarters/break room. 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.