Routine inspection·July 29, 2024

At approximately 12:15PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1 Year Required visit and met with Staff Member, Elsa Bacsal. Administrators, Tom Yuan and Sherry Zhu arrived during visit at approximately 12:45PM. Facility is a Residential Home for the Elderly that provides care and assistance for Older Adults with Disabilities. Facility has an approved fire clearance and capacity for 4 Non-Ambulatory Residents. Upon arrival, LPA was informed that there were 4 residents in care, with 2 residents out of the community attending Day Program. LPA was also informed that there were 2 staff members on site. At approximately 12:30PM, LPA reviewed the Facility's Staff Roster and found that all staff on site were background cleared and associated to the facility per regulation. At approximately 12:35PM, LPA conducted a walk-though of the facility with Staff Member. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a one story building with 4 resident bedrooms, 2 bathrooms, and common spaces. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Mattress pads were in place or available for resident use. Toxins were observed to be stored inaccessible to residents. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Administrator's Certificate for Xiaotong (Sherry) Zhu (6003088740) currently pending. Fire extinguishers were last inspected May 2024. Smoke detectors and carbon monoxide detectors were tested and operational. Facility's last emergency drill was conducted in July 2024. LPA reviewed staff files, resident files, resident medication, and resident P&I monies. All files were all found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. Medication was centrally stored and secure. P&I monies were documented, secure and not commingled. Continued on LIC809C Continued from LIC809 LPA requested the following documents to update facility file: Affidavit regarding Client/Resident Cash Resources (LIC 400) Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610D) Updated Personnel Report (LIC 500) Surety Bond (LIC 402) Updated Liability Insurance Active and Current Administrator Certificate Documents to be submitted to Community Care Licensing (CCL) by due date of 8/29/2024. No Deficiencies Cited during visit. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.