Routine inspection·November 5, 2022

Licensing Program Analyst (LPA) Bennette Pena conducted a Required Annual visit. LPA met with caregiver, Luz Yanina Cota who assisted with the tour of the facility. At 2:30pm, Administrator Hong Wei He arrived. The facility cares for elderly residents with dementia and licensed to serve 1 bedridden and 5 non-ambulatory residents. Waiver is approved to retain 1 resident on hospice. There is currently no resident on hospice. This single-story home contains six (6) bedrooms, of which one (1) is for the caregiver, three (3) bathrooms, a living room, kitchen, dining area, backyard, and storage room in the backyard. LPA observed that the facility does not have a swimming pool or other bodies of water. The facility was toured along with caregiver Luz Yanina Cota and observed/inspected the following: The facility had a universal entrance screening area including a thermometer, PPE supplies, screening logs, and sign-in sheet. Caregiver screened the LPA upon entry. COVID-19 posters and signs were placed in several areas of the facility. Facility maintained a 30-day supply of PPE located in the supply closet inside the home and in the storage room in the backyard. Staff wore a face mask throughout her shift. (6) Bedrooms have the required furniture such as bedframes, dressers, lamps and chairs. Beds have the required linen and the linen is in good condition. 3 bathrooms have the required grab bars in the shower and near the toilet. The bathrooms are clean and have the required hygiene items.However bathroom # 2's shower is not being used. There are boxes and supplies placed in the shower area. Bathroom #3 hot water reading in the shower is 121.3 deg. F, which is not within the required Titled 22 regulations. ***Refer to LIC 809C for the continuation of this report. At 2:05pm, the hot water temperature in the kitchen was 116 degrees during the visit. At 2:10pm, bathroom #1 hot water temperature was 118.9 deg F and bathroom #2 reading was 119.3 deg. F. All are within the required 105 - 120 degrees. The facility temperature at the time the visit was comfortable.There is sufficient lighting throughout the facility. There are smoke detectors in the bedrooms and common areas and carbon monoxide detector near the kitchen and are working properly. The kitchen was inspected. There is sufficient 2-day perishable and 7-day non-perishable food. During the visit, LPA observed the cleaning solutions are unlocked under the kitchen sink cabinet which is accessible to residents. There are cameras in the common areas and no audio. LPA did not observe any cameras in the private areas. LPA observed one (1) fire extinguisher in the kitchen and is fully charged and last serviced on February 10, 2021. LPA observed that the auditory device on one of the exit doors next to Bedroom #3 is inoperable. The laundry area is located outside and LPA observed the cleaning/laundry supplies are out and accessible to residents. Medications were locked and centrally stored. Medications were reviewed for all residents and facility maintained a 30-day supply of medications. Residents' medications were not documented properly. The common areas such as living room and dining room are clean and have the required furniture. The front yard is well maintained. There is a empty water fountain in the backyard. The backyard has a shaded area and sitting area. The backyard has been designated as the visitor area during the COVID-19 pandemic. Clients files were reviewed to confirm emergency contact is updated and residents have health screenings and or vaccinations Client files were inspected, and emergency contact information was up to date. Hongwei He's Administrator certificate expires on 8/06/2023. Staff files were reviewed to confirm health screenings and fingerprint clearances. Residents have complete appraisals on file. Residents have complete admission agreements on file. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed are documented on 809D. Exit interview held. A copy of the report and appeal rights were provided to the Administrator, Hongwei He.