Routine inspection·July 17, 2025

***This is an amendment of the original report. The purpose of the amendment is to add identifiers in the Deficient Practice Statement on the LIC 9099-D (citation). There citations stands and remains the same.*** Licensing Program Analyst (LPA), Mayra Cota, conducted the required annual inspection visit. LPA arrived unannounced and met with Jacqueline Cortez, Executive Director. The purpose of the visit was explained. The facility is licensed for 150 non-ambulatory residents, ages 60 and over, of which (20) may be bedridden. There is a hospice waiver approved for (20) residents. Facility is operating within the scope of its license. The facility is located in a residential area of Temple City and the building consists of: (89) resident rooms with bathroom included in each room, main entry lobby/lounge, (5) administrative office, medication room, kitchen, (2) dining rooms, (2) patios/courtyards, movie theater room, activities room, (6) staff/visitor restrooms, garden room, staff break room, (2) maintenance/housekeeping storage rooms, chemical room, record room and parking lot. LPA toured the facility inside and out. LPA, randomly selected (10) resident rooms to inspect as well as the common areas. Hot water temperature in resident bathrooms were tested and measured within the range of 105-120 degree F. Each resident room has the required furniture, closet space, and lighting. However, LPA observed a safety grab bar in (1) resident shower breaking off the wall. The rooms have call buttons located by the resident's beds which were tested and operating during visit. A fireplace was observed and was adequately covered. There are no items nor debris obstructing the walkways. There are no swimming pools or other bodies of water on the premises. The facility has smoke and carbon monoxide combo detectors that are hardwired and connected to the fire department. Several fire extinguishers were also observed throughout the facility and were observed charged. The kitchen was inspected however, several live cockroaches were observed in the dishwashing area, the kitchen sink did not have the hot water warning sign posted by the sink, two dry food containers for rice and oatmeal's lid observed broken and content was exposed and two kitchen staff observed without a hair net during food preparation were observed during visit. ***Continues on LIC 809-C Adequate food supplies of 2 day perishable and a week of nonperishable were observed. Ten (10) staff and (10) resident records were randomly chosen and reviewed. Records reviewed had the required documents in place. Staff are fingerprint cleared and associated to the facility. Resident files contain the admission agreement, medical assessment with TB results, consent forms, property valuable form, pre-appraisal form, and care plan. Medication review was conducted. Resident medication is centrally stored in the medication room. The facility uses an electronic Medication Administration Record (MAR) log to document medications given. LPA reviewed (10) resident medications; however, medication errors were observed. LPA observed a medication present in the bubble pack and not given to a resident which should have been administered on 7/8/25 (Famotidine 20 mg) Staff interview indicated, they forgot to give the resident the medication at the time it was due for administration. Also, an evening medication was administered too early on 7/17/25. LPA observed missing medication in the evening slot for 7/17/25 (Quetiapine Fumarate 25 mg). Deficiencies are noted on LIC 809-D. Exit interview was conducted with Alisa Dean, Business Office Manager due to administrator leaving for a prior engagement, and a copy of this report and Appeal Rights were provided.