Routine inspection·April 21, 2025

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. At around 1:00 PM, LPA Tea was greeted and granted entry into the facility by caregiver staff and explained the reason for the visit. Administrator (AD) Tin Le arrived shortly to assist with the visit. The facility is licensed for a capacity of six, which two are ambulatory and four are non-ambulatory, with a hospice waiver for four. Currently there are six residents, and there are none on hospice during today's visit. At 1:29 PM, LPA Tea reviewed six resident files and two staff files. Resident files and staff files contained all required documentation. The administrator certificate expires on November 28, 2026. LPA Tea along with AD Le toured the facility at 2:14 PM. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of 5 resident bedrooms, which one is shared, 3 full bathrooms, living room, kitchen, laundry room and attached garage and resting area for caregivers. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. 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 117.3 Fahrenheit degrees and 119.6 Fahrenheit degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including dressing, bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps secured in a kitchen drawer. LPA also observed toxin substances to be secured and locked and inaccessible to clients underneath the kitchen sink and Annual Inspection continued LIC809C garage. The fire extinguisher in the kitchen is fully charged. The facility’s last fire drill was conducted on March 1, 2025. Kitchen appliances are operational during today's visit. LPA observed emergency food and water supply in the garage. LPA toured the outside grounds and there is ample seating with shade and exit gates are on both sides of the house that are self-latching and operational. Facility provides activities based on resident’s personal preference and health condition and limitations. The residents do puzzles, some go out for walks and do exercise. At the time of the visit, LPA observed residents watching TV and enjoying their meals. At 2:36 PM LPA reviewed medication storage and administration. Medications are stored in a locked cabinet in the kitchen. Medications are being administered per physician order. LPA interviewed clients regarding their quality of care and spoke to staff present regarding care provided. Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with Administrator Tin Le and a copy of this report LIC809, 809-C, LIC858, LIC859, was read and provided to the facility.