Routine inspection·September 11, 2023

Licensing Program Analysts (LPA) Tao conducted an unannounced visit to the facility for purpose of an annual inspection. LPA met with Phuoc Truong, administrator, who assisted with the visit. The facility is licensed to serve Residential Care Elderly to serve elderly, ages 60 years old and older, and has dementia program. The capacity is six (6) including five (5) non-ambulatory and one (1) bedridden. The facility has approved of six (6) hospice waiver. Currently, five (5) residents are non-ambulatory and no bedridden residing at the facility. Annual licensing fees are current. Administrator certificate is current and the expiration date is 12/5/23. Two live-in staff are residing in bedroom #6. During the visit, the infection control domain tool was used, a tour of the facility was conducted, food supply was reviewed, and staff/residents were interviewed. LPA toured the facilities physical plant, indoor and outdoor. The facility is located in a residential neighborhood. Facility is a single house with six (6) resident bedrooms, two (2) bathrooms, living room, kitchen, backyard with shaded area, and laundry room. Passageways, walkways, driveways, steps and patios are free from obstructions. Residents' bedrooms and bathrooms are spacious and will easily accommodate the residents furnishings. Common areas were observed for the ability to safely serve the needs of the residents. Hot water temperature was 113.0 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies was observed. No pools and bodies of water on the premises. Facility maintained a comfortable temperature for residents. Auditory alarm devices to monitor exits were operable. Last fire drill was conducted on 7/10/23. (-continued in LIC 809C-) Sufficient supply of perishable and nonperishable foods is observed. Knives, tools, sharp items are inaccessible to residents. Smoke detectors and carbon monoxide detectors are operable. Fire extinguishers’ last service is 8/21/123 and are fully charged. Due to insufficient time, this annual visit needs a further inspection for staff/residents file reviews, medication reviews and complete the other domains in CARE tools. An Exit interview was completed with Administrator. A copy of this licensing report LIC 809 was provided.