Routine inspection·March 23, 2023

Licensing Program Analyst (LPA) Christine Wong conducted the required annual inspection. LPA arrived unannounced and met with Administrator Sang Heng allowed the entry of the facility. The purpose for the visit was explained. The facility is licensed for AGE RANGE 60 AND OVER. 6 NON-AMBULATORY, OF WHICH 1 IS BEDRIDDEN. HOSPICE WAIVER FOR 3 . Facility has fire clearance for 6 non-ambulatory residents, one of which is bedridden. Currently there's no resident reside in the facility. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: The facility does not have a infection control plan in file and administrator does not have a health screening report with chest x ray Operational Requirement: The facility does not have any proof of liability insurance for the facility. Physical Plant and Environmental Safety: The facility includes family room, dining area, kitchen, living room, three residents rooms and two bathrooms and storage room. The bathrooms are clean, sanitary and in a good working condition. The bathrooms also have grab bars and non-skid mat. LPA checked the hot water in the bathroom and its tested at 67 degrees F. and its below the range of Title 22 regulation. LPA also observed there was all purpose cleaner which are stored on top of the toilet which are not locked. Staffing: Currently no staff is working at the facility. Personnel Records- Training: The administrator (Sang Heng) certificate is expired and currently no staff is working at the facility. Resident Records/Incident Reports: Currently facility has no residents reside Residents Right Information: LPA did not observe any poster for complaint's information or resident right in the facility Planned Activities : Currently there's no residents reside in the facility Food Service: Currently there's no resident reside in the facility. (See LIC 809C for continuation) Incident Medical and Dental: Currently there's no resident reside in the facility and therefore there's no medication in the facility. Disaster Preparedness : Facility does not have an updated emergency and disaster plan posted in the facility Residents with Special Health Needs: Currently there's no resident reside in the facility. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8 Exit interview was conducted, Appeals Rights discussed and a copy of the report was given to the Administrator Sang Heng