Routine inspection·December 9, 2024

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by caregiver Isabel Vargas and explained the reason for the visit. Licensee (LE) Ban Nguyen arrived shortly to assist with the visit. Facility is licensed for six non-ambulatory residents, of which one may be bedridden and with a hospice waiver for six. Currently there are five residents, of which two are on hospice during today's visit. LPA Tea reviewed five resident files and two staff files. There were discrepancies noted in the review of resident and staff files. Administrator Honglan Tran’s administrator certificate expires on July 30, 2026. LPA Tea along with the Administrator toured the facility at 2:19 PM. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a single-story home that consists of 5 resident bedrooms, 1 caregiver room, 3 bathrooms, spare/storage room, living room, dining room, kitchen, office area and garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms and 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 around 109 F 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 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 locked in a kitchen drawer. LPA also observed toxin substances to be locked and inaccessible to clients in care secured underneath the kitchen sink. The fire extinguishers throughout the facility were fully charged. Kitchen appliances are operational during today's visit. Annual inspection continued on LIC809-C LPA toured the outside grounds and there is ample seating with shade in front of the house. LPA observed emergency supplies and water in the garage. Licensee had ordered emergency food already and will arrive shortly to the facility. Facility provides activities based on resident interests. The residents watch television, listen to music, play bingo, color, arts and go for walks outside. There is also music therapy, and they love to dance. At the time of annual visit, residents were seen watching television, walking around the front yard and doing word search puzzles. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet in a staff area. Medications are being administered per physician order. LPA interviewed residents regarding their quality of care and spoke to staff present regarding care provided. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Licensee Ban Nguyen and a copy of these reports were given to the facility along with a copy of the LIC 858; 859;809-D, 9102 and Appeal Rights.