Routine inspection·March 12, 2024

On 3/12/2024 at 1:00 PM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with caregiver, Carline Skang and explained the purpose of the visit. The facility’s fire clearance was approved for 6 non-ambulatory. Administrator, Yanlin Huang later arrived. LPA toured facility with caregiver including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 8 total bedrooms which 6 bedrooms are occupied by the residents and 2 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 70 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 114.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Smoke detectors and carbon monoxide dectector were in operating condition during visit. Fire extinguisher available. Emergency Disaster Plan was last posted on 03/12/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 09/01/2023. At 1:30pm, LPA reviewed 5 residents records. At 4:00pm, LPA reviewed 1 staff records and 1 of 1 have current first aid training and associated to the facility. Report continues on LIC809-C The Following Deficiencies were observed during Inspection: At 2:00PM during file review LPA observed R5's file missing all documents except an admission agreement and physicians report 87506(a) repeat violation At 2:20PM during facility tour LPA observed an unlocked knife in Kitchen drawer by the sink. 87705(f)(1) repeat violation At 2:30PM during facility tour LPA observed an individual sleeping in room 7 who is listed as ineligible on guardian 87355(e) repeat violation At 3:20PM during file review Administrator does not have a valid Administrators certificate. 87406(a) At 3:50PM during file review S3 did not have a file or any of the required documentation 87412(f) repeat violation At 3:50PM during file review S3 did not have a TB test on file 87411(f) At 3:50PM during file review S3 did not have First Aid 87411(c)(1) repeat violation At 4:00PM During file review S2 did not have a complete file with the required document. They only has a health screening, LIC 501, and CPR/First Aid. Other staff files unavailable 87412(a) At 4:30PM during file review Quarterly Disaster drill was not done. After notifying Administrator LPA observed administrator inputting a date for December 2023. 1569.695(c) repeat violation A civil penalty is being assessed today for $3000 for repeat violation of 87355(e) {$100 a day x 30 days} A civil penalty is being assessed today for $1250 for all other repeat violations {$250 per violation x 5} Civil penalty total= $4250 Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 03/31/2024: LIC 500 Personnel Report Current Administrator’s Certificate The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided by email.