Routine inspection·March 12, 2024

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Caregiver Yanina Cota. Administrator Fengpei "Pearl" Qin and Operations Manager arrived later. The following 12 (CARE) tool domains were utilized during the inspection: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor sign-in station located in the main entrance. The facility has an Infection Control Plan. Operational Requirements: A current Plan of Operation was reviewed. The facility serves residents 60 years and older, has a Dementia Waiver in place, and a Hospice Waiver for one (1) resident is approved. A fire clearance for 5 non-ambulatory and (one) 1 bedridden resident is place. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 7/1/2024. A surety bond is not applicable. Facility does not handle resident's money. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood consisting of 6 bedrooms; 5 for residents [4 private & 1 shared) and 1 staff bedroom, 3 bathrooms, living room, dining room, kitchen, outdoor covered patio area, laundry area is in the porch, and no garage. The facility has one (1) fully charged fire extinguisher. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. There is an empty water fountain located in the backyard. Kitchen drawers containing knives/sharp objects were locked. Water temperature readings did not measure within the required 105 - 120 degrees Fahrenheit. Water temperature in bathrooms was 141.0, 143.6, 143.2, and kitchen was 143.3 DF . Citation was issued. Staffing: A total of 3 caregiver staff provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificates expires 8/16/2025. Personnel files/training were reviewed. Staff training, health clearance, criminal background clearance and 1st Aid/CPR training was checked. Staff (S1- S3) have expired 1st Aid/CPR certificates. A citation was issued. Resident Records/Incident Reports: A total of four (4) resident files were reviewed. Files contained admission agreements, Physician's Reports, Appraisals, TB clearance, COVID-19 vaccine cards, Functional Capability Assessment, and emergency information. However, Dementia residents (R2- R4) had Physician Reports that were dated 2021 & 2022. RCFE complaint poster and Personal rights were observed posted in the facility hallway. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Indoor and outdoor activities are performed daily. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and storage areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Physician orders for modified diets are in place. Incident Medical and Dental: Four (4) centrally stored resident medications were reviewed. Resident (R1) observed to have a 30-day supply of medications. Medical and dental transportation is provided by family, transportation services, or staff. Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place. The last emergency disaster drill was conducted on 1/12/2024. Residents with Special Health Needs One (1) resident is receiving home health services. No residents are enrolled in hospice care. All resident beds had full rails, but none of the residents are enrolled in hospice care. Citation was issued. Individual Service Plans and Appraisals were observed in resident files. Resident (R3) has a G-tube and is not enrolled in home health care and no health care plan was observed on file. Citation was issued. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Administrator Fengpei "Pearl" Qin. A copy of the report and appeal rights were issued.