Routine inspection·March 14, 2025

Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection on 3/14/25. LPA arrived unannounced and met with Staff, Eva Nainggolan. The purpose for the visit was explained. 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. There is a hospice waiver approved for 4 residents. The facility is vendorized by the San Gabriel/Pomona Regional Center. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools to inspect the facility today. The single story facility consists of 4 resident bedrooms, 2 staff rooms, 2.5 bathrooms, living room, dining room, kitchen, and attached garage. Fireplace is secured by a fence. There are video surveillance in the common areas of the facility. Facility has interconnected smoke detectors and carbon monoxide detectors at the home. Knives, cleaning solutions, and disinfectants are locked. The hot water temperature was measured between the required range of 105-120 degrees F. Sufficient food supplies are observed. The facility has a dementia care plan to accept or retain residents with dementia. LPA reviewed 3 personnel files. Staff employed have fingerprint clearance and associated to the facility. The files contain the personnel record, health assessment, TB test results, and annual training hours. Staff have current CPR & First aid certificates. LPA reviewed all 4 resident files. The 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. Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical/mental capability. Medications are centrally stored in the kitchen cabinet and they are being administered as prescribed by the physician. The updated Emergency Disaster Plan is reviewed annually by the administrator. However, LPA provided a technical violation for the emergency disaster drills. There are no deficiencies issued today. An exit interview was held and a copy of this report was emailed to the administrator.