Routine inspection·March 5, 2024

Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection on 3/5/24. LPA arrived unannounced and met with Staff, Eva Nainggolan. The purpose for the visit was explained. Administrator, Trupti Mody, arrived shortly after to assist with the visit. The facility is licensed to serve 4 non-ambulatory residents ages 60 and over, of which 1 may be bedridden. Bedroom #5 is approved for the bedridden resident. The facility serves developmentally disabled residents who are placed by the San Gabriel/Pomona Regional Center. There are currently 3 non-ambulatory and 1 ambulatory residents residing at the facility. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools and observed the following: The single story facility consists of 4 resident bedrooms, 2 staff rooms, 2.5 bathrooms, living room, dining room, kitchen, and attached garage. The fireplace is secured by a fence. There are no swimming pool or bodies of water on the premises. Facility has interconnected smoke detector in each room and 2 carbon monoxide detectors at the home. Knives, cleaning solutions, and disinfectants are locked, making them inaccessible to residents. The hot water temperature was measured between the required range of 105-120 degrees F. The facility staff are using appropriate hand hygiene and wearing gloves while assisting residents. The facility has a dementia care plan to accept or retain residents with dementia. LPA reviewed 4 personnel files. Staff employed have fingerprint clearance and associated to the facility. They have the required documents and training hours in their files. Staff have current CPR & First aid certificates. Resident files are also maintained at the facility and have the following documents in their files such as Admission Agreements, Identification & Emergency Information, Physician's Report, Regional Center's IPP reports, and Resident rights. The Complaint poster, Local Ombudsman, and Residents personal rights are posted. Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical/mental capability. There are sufficient food supplies of 2-day perishable and a week of non-perishable items. The food are properly stored in the refrigerator. Medications are centrally stored in the kitchen cabinet. LPA reviewed 4 resident medications and they are being administered as prescribed. The facility has the Emergency Disaster Plan with contact numbers, at least 2 relocation sites, and procedures in case of emergency. There are no deficiencies issued today. An exit interview was held and a copy of this report was given to administrator Trupti.