Routine inspection·February 20, 2025

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit for the purpose of conducting the required annual inspection. LPA was greeted and granted entry by care giving staff after explaining the purpose for the visit. Administrator (AD) Kevin Bim was notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Kevin Bim has a valid Administrator certificate which expires on June 8, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, of which one may be bedridden, and has a hospice waiver for three. The facility is a single story home with four resident bedrooms, of which two are shared, one staff room, one shared resident bathroom, a living room, a dining room, a kitchen, a game room, and an unattached two car garage. LPA, accompanied by the AD conducted a tour of the interior portion of the facility. On today's visit, LPA observed six residents in care and two care giving staff present. LPA observed the resident relaxing in their respective bedrooms and in the common areas. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall in the resident hallway. LPA inspected all four resident bedrooms and they were observed to be free of any hazards. LPA observed the resident bedrooms had all the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds had clean linens and blankets. LPA observed additional linens are stored in a hallway cabinet. LPA inspected the one shared resident bathroom. The resident bathroom is clean. Resident bathroom was equipped with grab bars and a nonskid floor mat. The faucet and toilet was operational. Hot water temperature measured 107.4 degrees Fahrenheit. LPA observed the staff room to be free of hazards. LPA observed that the kitchen has a two day perishable and a seven day nonperishable food supply on hand. The kitchen is clean and appliances were operational. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed toxins and chemicals to be stored in a locked kitchen cabinet under the sink. CONTINUED ON LIC809-C A fire extinguisher is located in the kitchen and it was observed to be charged and up to date on service. LPA tested the smoke detectors and carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on September 17, 2024. The centrally stored medication is kept in a locked cabinet in the resident hallway. LPA observed a First Aid Kit to be stored in the locked cabinet and it was observed to have all the required components. LPA observed a fireplace in the living room and it was observed to be adequately fenced and not in operation at time of visit. LPA, accompanied by the AD conducted a tour of the exterior portion of the facility. LPA observed the exterior portion of the facility to be free of obstructions and hazards. LPA observed the unattached two car garage is kept locked and inaccessible to residents in care. LPA observed the garage to be used for storage. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gate on the north side and south side of the facility are self-latching and can be open in an evacuation. There are no bodies of water on the premises. LPA reviewed all six resident files. LPA observed that the Reappraisals for Resident #1 (R1), Resident #5 (R5), and Resident #6 (R6) were outdated. LPA observed that the facility did not have a Reappraisal on file for Resident #3 (R3). LPA reviewed all six residents' medication and medication records. LPA observed that Resident #3 (R3), Resident #5 (R5), and Resident #6 (R6) were being provided medication without the proper Physician's order. LPA reviewed four staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Kevin Bim. A copy of the report and Appeal Rights were provided.