Routine inspection·March 27, 2025

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents of which one may be bedridden. Facility has an approved hospice waiver for 3 residents and the home currently has 5 residents, with 1 resident on hospice. Administrator (AD) Chin-Wen Cheng arrived shortly to assist. AD has a valid certificate that expires on 9/16/2025. AD provided updated liability insurance that expires on 2/22/2026. LPA along with staff 1 (S1) toured the facility at 8:35 AM. LPA toured the physical plant, checked food service, facility documentation and the first aid kit. The home consists of 5 resident bedrooms, living room, dining room, staff room, staff bathroom, 2 resident bathrooms, and kitchen. At 8:38am, LPA observed 1 out of 5 stove burners to be non-operational. LPA observed sharps locked in a kitchen cabinet during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 105.2 degrees F and 112.6 degrees F in all bathtrooms check. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPAs reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts quarterly emergency drills with the last drill conducted on 12/10/2024. Continued on LIC809C dated 3/27/2025. Outside grounds were toured. Walkways around the home were clear of hazards. At 9:05am, LPA observed there is no shaded outdoor seating for residents. Exit gates are unlocked and operational. There are no security bars or weapons on the premises. First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of exercise, music therapy, and board games. LPA observed the emergency food and water supply. LPA reviewed five resident files and two staff files. All resident files contained required documentation including physician reports, resident appraisals, and physician orders for bed rails as indicated. 2 out of 5 resident files did not have admissions agreements. Staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training. LPA reviewed medication storage and administration. Medications are stored in a locked closet. Based on the observations made during today’s visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided along with appeal rights.