Routine inspection·April 18, 2024

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 four (4) non-ambulatory and two (2) bedridden, ages 60 years old and above. The facility has an approved Hospice Waiver for six (6) residents. Currently, there are two (2) resident on hospice in placement. Administrator certificate is current and the expiration date is 11/30/24. During the visit, LPA completed the Care tool, interviewed staff/residents, reviewed staff/residents' records, toured the facility, reviewed food supply and medications. The facility is a single-family residence located in a neighborhood, consists of six (6) bedrooms, five (5) bathrooms, kitchen, dining room, laundry room, family room, administrator office, activities room, detached garage, and living room with a TV. Passageways, walkways, entrance and patio were free from obstructions. Rooms were furnished with appropriate furniture for residents’ comfort and in compliance. The bathrooms were furnished with grab bars and nonskid surfaces. Common areas were observed for the ability to safely serve the needs of the residents. Facility maintained a comfortable temperature for residents. Auditory alarm devices to monitor exits were operable. The outdoor activity area had a shaded patio with ample seating. Hot water temperature was measured in a range of 110.2 - 115.5 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies was observed. Sufficient supply of perishable and nonperishable foods was observed. Knives, tools, sharp items were inaccessible to residents. Smoke and carbon monoxide detectors were dual/hardwired and operable. Fire extinguishers were fully charged. Mandated documents and signages were posted in common areas. Medication was centrally stored in a locked cabinet. Resident records were stored in a locked cabinet. Deficiencies were observed and cited per California Code of Regulations, Title 22, in LIC 809D. An exit interview was conducted and this report/appeal rights were provided to staff#2.