Routine inspection·October 6, 2025

On 10/06/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Annual Visit to the facility listed above. LPA met with Licensee Ke Sun, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The facility is licensed to serve six (6) non-ambulatory residents aged 60 and over and have an approved hospice waiver for four (4). Physical Plant The facility is a single-story home in a residential neighborhood. The home consists of four (4) resident bedrooms, staff room, three (3) bathrooms, living room, sitting room, office area, kitchen, laundry room, detached garage, front and back yard. LPA observed a shaded patio with table and chairs. All windows and screens were observed clean and in good repair. LPA observed all walkways around the facility are clean, clear, and free of debris, hazards, and obstructions. All fences open easily from the inside to exit. The facility does have a fireplace that is screened and inaccessible to residents. Bedrooms LPA inspected all resident rooms and observed them to be clean and in good repair. LPA observed the rooms have the required furniture including a bed, dresser, nightstand, chair, and storage space for personal belongings. LPA observed the beds have the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillows. LPA observed a supply of linens in a cabinet in the hallway. All linens and mattresses were observed in good repair. All bedrooms were observed to have ample lighting. Bathrooms LPA inspected all bathrooms and observed them to be operable and within Title 22 regulations. The toilet, facets, and shower work properly. The bathrooms were observed clean and showers free of mildew and mold. The showers were observed with secured safety handrails, nonskid mats, and a shower chair. LPA observed storage space for residents’ hygiene products. LPA observed an ample supply of towels in a cabinet in the hallway. LPA observed a supply of hygiene products available for residents in a closet at the entrance of the facility. The water temperature measured between 112.3 -degrees, 111.4- degrees and 115.6 -degrees Fahrenheit. Kitchen LPA inspected the kitchen and observed it to be clean and sanitary. LPA observed all appliances to be operational and in good repair. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods properly labeled, dated, and packaged. The water temperature measured 110.2-degree Fahrenheit. LPA observed an ample supply of cookware, dishware, and cutlery. LPA observed knives and sharps are secured in a locked cabinet in the kitchen and are inaccessible to residents. LPA observed cleaning supplies are secured in a locked cabinet under the kitchen sink and are inaccessible to residents. Common Rooms In the living room LPA observed a couch and chairs to accommodate all residents. In the sitting room LPA observed chairs available for residents. The dining room has a large table with chairs to accommodate all residents. LPA observed in the laundry room a washer and dryer in good repair and are operational. All cleaning supplies and detergents were observed secured in a locked cabinet above the washer and dryer. All walkways and hallways in the facility were observed to be clean, clear, and free of obstructions and hazards. LPA observed ample lighting and night lights in all common rooms, walkways, and hallways. LPA observed games, activities and reading material available for residents. Medications LPA observed all Centrally Stored Medications were secured in a locked cabinet in the dining room and are inaccessible to residents. All medications were observed in their original containers. LPA reviewed the medications and Medication Administration Record (MAR) for five (5) residents. LPA observed five (5) out of five (5) resident’s medications are consistent with properly documented records. Safety LPA observed and reviewed the facility Disaster Plan and Emergency Plan (last reviewed on 07/12/2025) and emergency numbers posted in the facility. LPA observed all required posting posted. LPA observed smoke detectors and carbon monoxide detectors are operational. LPA observed a facility sketch posted in the workspace in the sitting room. LPA observed two (2) fully charged fire extinguishers, one mounted in the kitchen and the other in the laundry room, last serviced on 07/21/2025. The last Emergency Drill was conducted on 09/12/25. LPA observed emergency flashlights in a drawer in the office area in the dining room. LPA inspected the First Aid Kit and observed it had the required items and a current manual. The facility has a working telephone. There are no firearms or ammunition on the premises. Files LPA reviewed the files for five (5) residents and observed they contained the required documents. LPA reviewed the administrator and three (3) staff files and observed they contained the required documents, clearance, certification, and training. The administrator’s Administrator Certificate, number 6071632740 is valid till 07/24/2026. LPA received and reviewed a copy of Liability Insurance through IPFS Corporation of California that is valid till 08/21/26. LPA informed Licensee that Licensing Fees are due on 10/22/2025. Infection Control LPA observed the facility’s Infection Control practices. At the entrance of the facility is a sanitizing station. LPA observed a Visitor Log with screening and temperature log. LPA observed hand sanitizer and masks available. LPA observed infection control signs posted throughout the facility. LPA observed a 60-day supply of Personal Protective Equipment (PPE) in the closet in the sitting room and in the garage . During today’s visit, LPA did not observe or cite any deficiencies. An exit interview was conducted with Licensee, Ke Sun, and a copy of this report was provided.