Routine inspection·December 7, 2024

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Angelica Juarez and explained the reason for the visit. Administrator arrived shortly after. The facility is licensed to serve 99 non-ambulatory residents over the age of 60 with a hospice waiver for 5. The facility is located in a commercial residential area and consist of a two story building with a commercial kitchen, dining room, library area, TV area, offices, reception, a courtyard, residents rooms in the first floor. The second floor consist of a lounger area and residents bedrooms. Each resident bedroom has a private bathroom. LPA Flores toured the facility with Angelica Juarez and observed the following: Common areas are clean and in good repair. Library provides a variety of reading material. Kitchen is in good repair, clean, food was observed sufficient for at least 2 days of perishables and 7 days of non-perishables. List of special diets was posted in the kitchen. LPA observed a total of 6 resident bedrooms each has the required furniture and bedding supplies, with sufficient lighting. Bathrooms were observed in each room in working condition. Grab bars were missing around or inside the shower in room #109, 229, and 240. Per staff showers have been recently replaced. Water temperature was tested in the resident's bathrooms and tested between 104.7-118.2 degrees F., which is not within the required 105-120 degrees F. Room #129 water temperature tested at 104.7. Facility has a fire sprinkle system throughout. Fire extinguishers have been observed throughout which were last checked on 4/4/24. Courtyard was observed in good repair with shaded seating area. No large bodies of water were observed. Medication room, cleaning supplies, and sharps were inaccessible to the residents. Second floor has sunlight panels in the roof, the panel above the lounge room was observed broken with an opening of about 16in by 24in covered with cardboard. (CONT. LIC 812) Per administrator it was broken by solar panel installers that came in on 12/5/24 and a quote for repairs is being obtain. Laundry room was observed. Sufficient linens were observed. Cleaning supplies and PPE supplies were observed. Emergency food supplies were observed in a closet in the second floor. All passage ways are clear and free of obstructions. Required posters were observed in the common areas and visible to the residents. Evacuation chairs were observed on top of each staircase (3). LPA tested alert call button which is in working condition and caregiver responded within 5 minutes. LPA observed half bed rails in bedroom #129 and a physician's bed rail request was observed in residents file. LPA reviewed medication and files for 5 residents and 5 staff files. Staff received 20 hours of training for the current year. Administrator certificate was observed for Jane Kim #6022176740 exp. date: 11/29/24. Administrator submitted renewal documents to the department on 11/19/24. LPA interview 4 residents and 4 staff. Infection Control plan and Emergency Disaster plan were reviewed. Technical Violations have been noted today. No deficiencies were noted. Exit interview was conducted with Jane Kim and a copy of this report and technical violations were provided.