Routine inspection·May 20, 2025

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of conducting the Required 1-Year annual evaluation using the Care Inspection Tool. LPA was greeted and granted entry by Caregiver Imelda Navarro and explained the reason for the visit. Licensee/Administrator (Admin) Hanh Pham arrived on site to assist with the visit. Admin holds a valid certificate expiring on October 30, 2025. The facility is a single story structure is licensed to provide services for age range 60 and over for six non-ambulatory. A waiver was granted to provide hospice services to four residents at one time. During today's visit, there are no residents under hospice care and two staff providing care to five residents. LPA toured the physical plant with Caregiver Ma Alojado. Facility is clean and operational. LPA observed five resident bedrooms and three resident bathrooms. There is one additional staff bedroom occupied by two live in staff. Resident bedrooms had all required furnishings. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 115.3, 108.3, and 112.4 degrees Fahrenheit in the resident bathrooms. All common areas were inspected including the attached two car garage. LPA reviewed the Emergency Disaster Plan (LIC610E) last updated on March 13, 2022 and observed sufficient emergency food and water in the garage and kitchen pantry, however not all disaster supplies were obtained as noted on the LIC610E. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food available in the kitchen and garage. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. The exit gate is self-closing and self-latching. LPA observed sufficient seating and shading. The fire extinguisher was mounted and serviced on August 15, 2024. The auditory devices and smoke/carbon monoxide detectors were tested and operational. Emergency evacuation drills are conducted quarterly, however records are not maintained. Last drill started in December 2024 per Admin. The Complaint Poster, 'See Something, Say Something,' (PUB 475) was available and posted in the correct size. LPA conducted a review of all residents and two staff files. No discrepancies noted. Medications were audited in two out out of five residents. No discrepancies noted. Interviews were conducted with residents. No staff interviews conducted as both staff were assisting residents. The following items were addressed with the Admin: to submit a copy of the amended LIC610E and to obtain disaster supplies noted on the LIC610E, to maintain a log for the drills conducted, and to annually review the plan and to update as necessary. Based on the observations made during today's visit, no deficiencies are being cited. Advisory Notes (LIC9102s) are being issued. An exit interview was conducted with Licensee/Administrator Hanh Pham, and a copy of this report including the LIC809C, and LIC9102s were provided at the end of the visit.