Routine inspection·September 21, 2023

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with Kenny Yu, administrator, who assisted with visit. The facility is licensed to serve five (5) bedridden and one (1) ambulatory residents, ages 60 and above. The facility has an approved Hospice Waiver for six (6) residents. Currently, there is one (1) resident on hospice in placement. Administrator certificate is current and the expiration date is 11/30/24. During the visit, LPA completed the infection control domain tool, interviewed staff and residents, reviewed staff/residents' records, toured the facility, reviewed food supply and medications. The facility is located in a residential neighborhood. LPA toured the facilities physical plant, indoor and outdoor. LPA observed the facility is a single-family residence located in a neighborhood, consisting of six (6) bedrooms, three (3) bathrooms, kitchen, dining room, and living room with a TV. The entrance and side areas are free of hazards and debris. Rooms are furnished with appropriate furniture for residents’ comfort and in compliance. The bathrooms are furnished with grab bars and nonskid surfaces. Common areas are observed for the ability to safely serve the needs of the residents. No pools and bodies of water on the premises. Facility maintained a comfortable temperature for residents. Auditory alarm devices to monitor exits were operable. Interior and exterior space available to permit residents to wander freely and safely. The outdoor activity area has a shaded patio with ample seating. Hot water temperature was measured in a range of 113.2 - 119.5 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies was observed. Sufficient supply of perishable and nonperishable foods is observed. Knives, tools, sharp items are inaccessible to residents. Smoke and carbon monoxide detectors are dual/hardwired and operable. Fire extinguishers’ last service was 3/22/23 and were fully charged. (-continued in LIC 809 C-) Mandated documents and signages are posted in common areas. Medication is centrally stored in a locked cabinet in the living room and inaccessible to residents. Resident records are stored in a locked cabinet and inaccessible to residents. Toxic substances are inaccessible to residents. Outdoor facility space used for residents and leisure are completely enclosed by a fence with self-closing gates. Deficiencies were observed and cited per California Code of Regulations, Title 22 in LIC 809 D. An exit interview was conducted. This report was discussed with Administrator, Kenny. A copy of LIC 809s report and appeal rights were provided.