Routine inspection·April 11, 2025

Licensing Program Analyst (LPA) William Vanegas made an unannounced inspection for the purposes of conducting an annual inspection. Upon arrival LPA Vanegas was greeted and granted entry to the facility by Care Giver (CG) Taveewan Kaewma. LPA Vanegas explained the nature of the inspection and set up equipment. LPA Vanegas began a tour of the facility and observed the following. This is a one storied home with five bedrooms one of which is a staff room, and four of which are resident rooms. There are two and a half bathrooms all of which are shared for residents in care. LPA Vanegas observed kitchen area to be clean and free of debris, LPA Vanegas observed a gas stove, microwave, refrigerator, washer, and dryer all to be in good repair and operational. LPA Vanegas observed a two day supply of perishable food, and a seven day supply of non-perishable food, with a sufficient amount of emergency water on hand for residents in care, and staff on duty. LPA Vanegas observed resident rooms to be large enough to walk about freely, and no obstructions blocking the entry ways. LPA Vanegas observed all resident rooms to have the required furnishings such as clean linens in good repair, meaning no strains or tears, a lamp, chest drawer, enough storage space for personal belongings, a bed, and a chair. LPA Vanegas toured the outside of the facility and observed the following, there is a large backyard with no obstructions along the exit routes. Side doors are self latching and unlocked. There is an outdoor shaded sitting area, and it is available for resident use upon request. CONTINUED ON LIC809C LPA Vanegas observed resident restrooms to be clean and free of any mildew and debris. Water faucets and toilets tested operational. Restrooms have all required furnishings such as a shower chair, grab bars, and slip resistant floor matts. Water temperature tested between 115.5 and 117.3 degrees. LPA Vanegas observed all fire extinguishers to be fully charged and up to date, LPA Vanegas observed all smoke and carbon monoxide detectors to be in good repair and tested operational. LPA Vanegas reviewed first aid kit and observed for it to have all required items; such as a thermometer, adhesive tape, bandages, tweezers, and scissors. LPA Vanegas reviewed five resident files and two staff files all resident files contained all required documents, When reviewing all staff files they had required documents, however one out of two staff did not have an updated CPR and first aid certification. A deficiency was issued on todays date. Annual staff training was up to date. LPA Vanegas reviewed medications and medication administration log with AD Yaninee Asawadilokchai, and observed the following. All medications are being documented correctly, and per LPA Vanegas review all medications are being administered per physicians orders. Based on observations made during today's inspection deficiencies will be issued per title 22 chapter 8 division 6 of the California Code of Regulations. An exit interview was conducted with AD Yaninee Asawadilokchai, and a copy of this report was provided to the facility.