Routine inspection·June 20, 2024

On 6/20/2024 at 1:45PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with caregiver, Gilberto Hernandez and explained the purpose of the visit. Administrator, "Fiona" Shan Gao arrived two hours later. The facility’s fire clearance was approved for 6 non-ambulatory residents of which 1 may be bedridden and 2 residents may be under hospice care. LPA toured the facility including but not limited to bedrooms, bathrooms, dining area, kitchen, garage, and outdoor area. Smoke and carbon monoxide detectors were observed. Fire extinguisher was observed to be full and last serviced on 6/6/2024. One week of nonperishable and 2-day of perishable food supplies were available. Hot water temperature was measured at 102.5 degrees F in the hallway bathroom. LPA observed grab bars and non-skid mat in the bathrooms. There were adequate lights in each room. First Aid kit is complete. LPA reviewed 5 residents and 3 staff files starting at 2:45PM. LPA interviewed 2 residents and 2 staff. LPA reviewed a sample of resident's medications starting at 5:05PM. At 2:30PM, LPA observed open office area now has a sliding door and staff is sleeping in the room. LPA was informed that the door was created about two years ago without permit. At 3:10PM, LPA observed R5 does not have current medical assessment on file. At 3:50PM, LPA observed S1 does not have health screening (LIC503) on file. (Continue on LIC809C...) At 4:00PM, LPA observed facility have not been conducting disaster drill quarterly. At 5:30PM, LPA observed R1's bottle Acetaminophen was 500mg. However, R1's medication list dated 6/19/2024 states that Acetaminophen 325mg was ordered. The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and Health & Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights were provided.