Routine inspection·December 3, 2022

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced annual inspection focusing on the Infection Control Domain. LPA Pena was greeted by Lead Caregiver, Arianna Loera and discussed the purpose of today's visit. LPA was not screened upon entry, LPA had to ask the staff if anyone will be conducting the screening. Only then that Arianna checked LPA’s temperature and asked to sign in the visitor’s log sheet. Licensee, Michael Hsu was contacted by phone and told LPA that Administrator is not available until this afternoon and he will try to meet LPA at the facility in 1 ½ hour. The facility cares for the elderly and is approved for six (6) non ambulatory and hospice waiver for six (6). There are currently six (6) residents of which three (3) are ambulatory, two (2) are non-ambulatory and one (1) hospice. This single-story home contains six (6) bedrooms, four (4) bathrooms, a living room, kitchen, dining area, backyard, and detached garage. At 10:30am, LPA Pena and Lead Caregiver inspected the facility. Resident bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, light, and sufficient closet space. The trash cans in all the bedrooms did not have lids. Bathrooms have the required grabs bars and non-skid materials. The trash cans in all the bathrooms did not have lids. The hot water readings were: Kitchen 116.5 deg F, Bathroom #1 131.6 deg F, Bathroom #2 128.9 deg F, Bathroom #3 126.7 deg F and Bathroom #4 125.5 deg F which are not within the required 105 - 120 degrees. Resident #1 is under hospice care and his bed was observed to have full-length bed rails. A written order from his physician is maintained in his resident’s record. Three (3) residents (R2-R4) are using half bed rails. A written order from a physician indicating the need for the bed rails are also maintained in the residents’ record. The kitchen was inspected at 10:33am. There is sufficient perishable and non-perishable food. All the appliances are clean and are working properly. Cleaning solutions, knives and sharps were locked and inaccessible to residents. The laundry room is located next to the kitchen and is clean and has cleaning supplies inaccessible to residents. The common areas such as living/activity room and dining room are clean and have the required furniture. ***Refer to LIC 809C for the continuation of this report.****** The backyard has two (2) tables with chairs and are shaded. The backyard area has been designated as the visitor area during the COVID-19 pandemic. Exit doors have auditory devices that were operating at the time of the visit. There are two (2) fire extinguishers, one (1) located in the hallway and the other one in the kitchen. Fire extinguishers are fully charged and were last inspected on 4/07/2022. There are cameras in the common areas and there were no cameras seen in private areas. Licensee Michael Hsu arrived at the facility at 10:55am and assisted with the inspection. Resident files were reviewed to confirm emergency contact is updated and residents have health screenings and or vaccinations. Staff files were not reviewed at the time of the visit due to Licensee and staff do not have access the files. Licensee stated that only the Administrator has the key to access the staff files. One of the caregivers, Waldeck Pierre has been working in the facility since April 2022 but is not associated to the facility. Residents' medications were reviewed to confirm medication is given as prescribed and is documented properly. Pursuant to Title 22, deficiencies were cited on the attached 809D. An exit interview was conducted and a copy of this report and appeal rights were provided to the Licensee, Michael Hsu.