Routine inspection·September 12, 2025

On 09/12/2025 Licensing Program Analyst arrived at the facility to complete an unannounced annual visit. LPA met with Care Giver, Josephine Jo and Care Giver, Ryan Figueroe . LPA introduced self, explained reason for visit and was permitted entry into the facility. Administrator, Phoeun Marez was contacted and arrived some time later. L PA completed a tour of the facility inside and out. A health and safety check was completed on residents in care. 6 residents present during visit. 2 residents receiving hospice services at time of visit. Pathways and doors were clear and free from obstruction. Facility was without odor. Common areas were adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Resident rooms observed to have the required furnishings and with adequate lighting. Sharps, chemicals and medications were located in locked cabinets/closets and cupboards. LPA observed sufficient seating under covered patio areas. The following issues were observed during today’s visit: Interviews with 3 of 3 residents disclosed they are not able to request, or refuse services. Facility does not have a device for the residents to use or access. Facility does not have activities for the residents to participate. R3's file missing home health care plan reflecting services, frequency and duration of care. Training is not being completed and documented with staff by hospice. 2 of 2 staff files reviewed do not have the required training. Deficiencies cited per California Code of Regulations, Title 22, deficiencies are being cited on the attached 809D. If not corrected, the violation with have a potential risk to the health, safety and/or personal rights of residents in care. CONT... CONT... LPA requested the following documents to be submitted to CCL by 09/19/25: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-D), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) and a copy of liability insurance in order to update the facility file. Exit interview was conducted with Administrator, Phoeun. A plan of correction was developed by Administrator and reviewed by LPA. A copy of this report, deficiencies, TV's and appeal rights were discussed and provided to Administrator. TSP was discussed. An office meeting will be scheduled and TSP will be offered at that time.