Routine inspection·June 17, 2025

Licensing Program Analysts (LPAs) Blanca Gonzalez and Nune Margaryan conducted an unannounced annual visit using the Care Tool. LPAs met with Administrator Linda Fan and Sabrina Liu, Assistant Administrator, who assisted with visit. LPAs explained the reason for the visit. The facility is licensed for residents age range 60 and over. Approved for 29 non-ambulatory residents of which 14 may be bedridden. Facility approved Hospice waiver for 10. There are currently 10 residents on hospice. The facility is a two-story building. LPAs and Administrator toured the facility which included: random selection of resident bedrooms on both floors, Reception area, common area / activity exercise area, Administrator office / Medication area, laundry room, dining area, kitchen, linen supply room, cleaning supplies room, two public bathrooms, rest area (TV and computer room). The facility also has a large back patio area. The passageways, walkways and patios are free from obstructions. The backyard patio area is well maintained and there are no pools or large bodies of water. The common areas are clean and have the required furniture. The resident bathrooms have the required grabs bars and non-skid floor. The water temperature was tested in a random selection of resident bathrooms and was measured within Title 22 Regulation guidelines. Resident bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen, and the linen is in good condition. At the time of inspection, LPAs observed medications in rooms #122 and #125, on a bedside table and in an unlocked cabinet accessible to the residents. Also, medication (Nystatin cream tube) in room #122 observed without a prescription label. Continue 809C LPAs observed proper signage for residents’ rooms who are in hospice and use oxygen. Smoke/Carbon monoxide detectors observed throughout the facility and were operational. There are several fire extinguishers located throughout the facility and observed fully charged. Emergency drill last conducted March 11, 2025. Kitchen appliances are clean and were operating at the time of the visit. Sharps are locked in the kitchen and are inaccessible to residents. Food supply adequate stored in the kitchen, storage room and consists of the following: 2 days perishable and enough food supply for 7 days non-perishable. Cleaning supplies and toxins were observed in the laundry room and supply room locked and inaccessible to residents. LPAs reviewed (4) resident records to confirm emergency contact is updated, physician's reports are on file, and admission agreements are complete. (3) staff records were reviewed to confirm health screenings, training, and fingerprint clearances. LPAs reviewed (4) residents' medications. Medications are documented properly and given as prescribed. First Aid kit was fully stocked with current manual. Per California Code of Regulations, Title 22, the deficiencies observed are documented on the attached 809D. Civil Penalty was assessed for a violation of the same section within a 12 month period. LIC421FC was issued. Exit interview held. A copy of the report and appeal rights were provided.