Routine inspection·June 22, 2023

Licensing Program Analysts (LPA) Christine Wong conducted the required annual inspection. LPA arrived unannounced and met with caregiver Kevin Qin. Assistant administrator Anna Dong assisted with the visit and Administrator, Linda Fan , also arrived to assist the visit at around 11:00am. The purpose for the visit was explained. The facility is licensed for residents age range 60 and over. Approved for 29 non-ambulatory and 14 bedridden, Hospice Waiver for 10. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following 12 domains: 1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. COVID-19 screening is still in place. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. 2. Operational Requirements: The facility has a dementia care plan to accept or retain residents with dementia. Currently they have 6 hospice residents reside in the facility. The facility has the sufficient amount for liability insurance covering injury to residents and guests. 3. Physical Plant and Environmental Safety : The facility is a two story building, on the first floor, it includes: Reception area, common area (Read newspaper area and exercise area), Administrator office, Dining Area, Kitchen, linen supply room, cleaning supplies room, ten (10) residents bedrooms, laundry room, food storage room and two unisex public bathrooms. On the second floor, it includes seventeen (17) residents bedrooms, rest area (TV and computer room), public bathroom but currently used it as storage. The facility also has a large back patio area. The passag eways, walkways and patios are free from obstructions. On today's annual, LPA inspected five (5) residents bedrooms which include Room#101, #126, #128, #206 and #227. (See LIC809C for continuation) Each resident room has their own bathroom. Room#101 and #206 has two beds, two drawers, chairs, required beddings and sufficient lighting and closet space. Room#126, #128 and #227 has one bed, one chair, one drawer, required bedding and sufficient closet space and lighting. The resident bathrooms are clean, sanitary and in an operable condition. All resident bathrooms have grab bar and non skid mat/floor. Each resident room and bathroom have the signal system and they are working properly. The hot water temperature in Room#101 and #206 were tested between 100.2 and 100.7 degrees F. 4. Staffing: There is sufficient staffing at the facility. Staff does not have CPR and First Aid training except the administrator. 5. Personnel Record and Training: The facility administrator is Linda Fan and her administrator certificate will be expired on 11/15/2023 and she has sufficient training hours in file. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. The caregiver/direct care staff do not have required training hours including medication management and initial training. 6. Resident Records and Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Admission Agreements, Identification & Emergency Information, Physician's Report, Pre-admission appraisal, and Resident rights. For Resident#1 and #2 admission agreement and they are not using the Font size 12 and the admission agreement is double sized. 7. Resident Right-Information: The Complaint poster, Local Ombudsman, and Residents personal rights are posted are between the reception area and entrance area. 8.Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. 9.Food Service: The facility has sufficient food supply for 2 days perishable and 7 days non-perishable food supply. The food are properly stored in the refrigerator. 10. Incidental Medical and Dental: The resident's medication is centrally stored and locked in the administrator office. LPA reviewed five (5) residents medication and they all seemed updated and accurate, which contained 30-day supply of medication. (See LIC 809C for continuation) 11.Disaster Preparedness: The facility has an updated Emergency Disaster Plan dated on 6/22/23 The facility staff does not have annual emergency and disaster training. The facility does have two appropriate alternate shelter locations. 12.Resident with Special Health Needs: Currently there's no resident under Home Health Services. Six (6) residents are on hospice. No resident is on postural support and no residents have prohibited health condition. Half and full bed rails for mobility assistance were observed in resident rooms. Individual Service Plans and Appraisals are on file. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Administrator Linda Fan. A copy of the report and appeal rights were issued.