Routine inspection·September 13, 2023

On 9/13/2023 at 3:15 PM, Licensing Program Analysts (LPAs) L. Alexander and L. Hall, conducted an unannounced 1-Year Required inspection. LPAs met with Banaag Yamsuan, Administrator , and explained the purpose of the visit. The Administrator holds a certificate #6053359740 which expires on 11/11/2023. The facility’s fire clearance is approved for four (4) non-ambulatory residents. LPAs toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of four (4) bedrooms and two (2) bathrooms. No bodies of water was observed. A comfortable temperature is maintained at 76 degrees Fahrenheit. LPAs 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 110 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 08/18/2023. Emergency Disaster Plan was last posted on 01/23/2023. First aid kit was observed to be complete. Fire drill was last conducted on 04/11/2023. Continued on LIC809. Continued from LIC809. LPAs reviewed six (6) staff files all staff had current first aid certification. LPAs also reviewed all four (4) residents' files which were current and complete. LPAs observed the following deficiencies: At 3:56 PM, LPAs observed during rodent/mouse dropping in bottom kitchen drawer. At 4:11 PM, LPAs observed pink wheelchair chair in outside backyard At 4:12 PM, LPAs observed broken chest drawers, canvas picture, broken furniture, wood planks, broken white cabinet and carcass prop located outside in front yard LPAs requested the following documents to be submitted to CCLD by 09/20/2023. Resident Roster LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (last page) Liability Insurance Facility sketch Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties. Exit interview conducted. A copy of appeal rights and this report provided.