Routine inspection·April 16, 2024

Licensing Program Analyst (LPA)s Mary Flores and Christian Gutierrez conducted an unannounced annual visit at the facility using the inspection CARE tool. LPAs met with Winnie Tan and explained the reason for the visit. Administrator arrived 30 minutes later. The facility is licensed to serve 1 bedridden and 5 non-ambulatory residents age 60 and above, with a hospice waiver for 1. The facility located in a commercial/residential area and consist of three (3) cottage units, each unit consist of a living room, kitchen, a bathroom, and two (2) resident rooms, a front yard, two (2) garage, laundry is located in the garage, and a shed. LPAs toured the facility with Winnie Tan, and Checksim Lim and observed the following: Facility is good repair indoor and outdoor. Food supplies were observed in each unit and no grains, no pastas, no rice, no breads, no fruits were observed, few vegetables and meats were observed. No sufficient food supplies were observed sufficient for at least 2 days of perishables and 7 days of non-perishables. Kitchen in unit #2 (942) floor was observed dirty and cleaning supplies were observed accessible to the residents in a kitchen cabinet, under sink cabinet, and mirror storage. Unit #1(940) was observed with sufficient lighting, furniture, and bedding supplies. Bathroom does not have a skid mat in the shower. Bathroom's shower was observed with soap buildup and no skid mat was observed. Water temperature was tested at 109.4 degrees F. Unit #2(942) was observed with sufficient lighting, furniture, and bedding supplies. Bathroom does not have a skid mat in the shower. Bathroom's shower was observed with soap mildew buildup and no skid mat was observed. Water temperature was tested at 120.9 degrees F. Unit #3(944) was observed with sufficient lighting, furniture, and bedding supplies. Bathroom does not have a skid mat in the shower. Bathroom's shower was observed with soap/mildew buildup and no skid mat was observed. Water temperature was tested at 138.2 degrees F. Medication was observed in the refrigerator accessible to the residents. (CONTINUED ON LIC 809C) LPAs reviewed medication for 5 residents. LPAs reviewed staff roster and staff #1(S1) was observed working on unit #1 and does not have a background clearance, per administrator 4/16/24 was S1's first day working at the facility. During this visit LPAs concluded three CARE tool domains: Physical plant, Food Services, and Incidental Medical. LPA Flores will return at a different time to continue annual visit. Deficiencies were noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Hongwei He staff and a copy of this report, LIC 809D, and appeal rights were provided.