Routine inspection·January 29, 2024

On 1/29/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an annual visit. introduce self, stated the purpose of the visit and requested to meet with the Administrator. LPA met caregiver Ma Tersita Cabuhat. House Manager (HM) Phoeun Marez was called and arrived shortly. LPA toured facility with HM. Licensee Manprit Singh arrived later during tour. All four residents were present during inspection. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Extra linens were observed. An adequate supply of perishable and non-perishable food was observed. Refrigerator temperature is maintained at 33 degrees F and freezer at -5 degrees F. Medications were observed locked in hall closet. MARs were reviewed. Cleaning supplies and chemicals stored and locked in garage and laundry room. Fire extinguisher was observed with a purchased date of: 2/28/22 . Alll bedrooms were observed to have the required furnishings and with adequate lightening. The bathrooms were toured and observed operational during inspection. Non-skid mat and grabbed bars were observed. Hot water temperature was tested at 125.2 degree F in the bathroom 1, and 106.2 degree F in bathroom 2. Outside of facility toured and observed to be free of debris. Side gate observed self-closing and self-latching. Adequate outdoor seatings available for residents. All residents’ and staff files were reviewed. Two out of four residents’ files were observed did not have all the required documents. Two out of three staff files were observed did not have all the required documents and not associated to the facility. A deficiency and an immediate Civil Penalty of $1000 was assessed. See Lic 421BG is being cited on the attached Lic 809D in accordance to California Code of Regulations, Title 22, Division 6 see attached 809D. Exit Interview conducted. LPA received a copy of Lic 9282. The requested documents are to be submitted to CCL by 02/05/24: Lic 308, Lic 500, Lic 610E, current liability insurance, and current Administrator certificate. A copy of this report and appeal rights were provided to Licensee, whose signature on this form confirms receipt of this report.