Routine inspection·February 29, 2024

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Jeffrey Yang and explained the reason for the visit. The facility is licensed to serve 6 non-ambulatory residents age 60 and above. Facility has a dementia waiver and are allowed to care for 1 resident on hospice at any one time. The facility is a single-story home, located in a residential area. It consist of; an administrator office room, kitchen, living room, family room, dining room, 6 resident bedrooms, 1 staff bedroom, 3 resident bathrooms, 1 staff bathroom, a detached garage, a front yard and backyard. LPA conducted a tour with Jeffrey Yang and observed the following: Facility was observed in good repair indoors and outdoors. Living room/family room/dining room are all clean, and providing sufficient sitting area, and lighting. Medication cabinet was observed locked in the living room, and fireplace was observed covered. Kitchen area is clean, sharps were observed locked in a drawer. Sufficient food supplies were observed of perishables for at least 2 days and non-perishables for at least 7 days. Each resident room (6) were observed clean with sufficient lighting, furniture, and bedding supplies. Bathrooms (3) were observed clean in working condition with grab bars and skid mats in the showers. Water temperature was tested in each bathroom and tested between 106.7-112.8 degrees F., which is within the required 105-120 degrees F. Garage is used to stored cleaning supplies, and laundry area and it is not accessible to the residents. Backyard has shaded sitting area and a 5ft fence pool inaccessible to the residents. Carbon Monoxide/Smoke detectors were observed, tested, and in working condition. Fire extinguishers were observed and last checked on 12/6/23. Ramps, exit doors, and passageways are free of debris and obstructions. LPA reviewed files and medication for 5 residents and 3 staff. Resident #5(R5) does not have a current physician's report last dated 7/28/22 and no TB clearance on file. Resident #4(R4)'s physician's report notes resident as bedridden. Files for staff #4-5 (S4-S5)were not available for review at the time of the visit, no proof of TB clearance for S4-S5. (CONTINEUD ON LIC 809C) S4 is night staff no current First aid training on file. No training records for any staff within the last 12 months. Emergency Disaster plan and Infection Control plan were reviewed no record on when they were last update observed. Last emergency drill was conducted on 8/1/21. Administrator certificate was submitted for renewal on 8/22 for Jeffrey Yan # 6009748740 exp. date: 12/2/23 pending approval. Change of administrator was discuss and Mrs. Erlinda Yang will not be returning as the administrator. Mr. Yang will submit the requested documents by 3/8/24. Deficiencies are noted on LIC 809D per Title 22 Regulations. *Immediate $500 civil penalties have been assess for fire clearance* Fire Department was notified via telephone (message only) of bedridden residents (2) at the facility on 2/28/24. Exit interview was conducted with Jeffrey Yang and a copy of this report, LIC 809D, and appeal rights were provided.