Routine inspection·December 2, 2025

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 staff 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 six residents, of which one is on hospice during today's visit. LPA reviewed two staff files and six resident records. Resident and staff files contained all required documentation. Some completed forms need required signatures. Administrator Honglan Tran’s administrator certificate expires on July 30, 2026. The last disaster drill was conducted on December 1, 2025. LPA Tea along with the lead staff toured the facility. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a single-story home that consists of 6 resident bedrooms, 1 caregiver room, 4 bathrooms, storage room, living room, dining room, kitchen, office area and garage. 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 around 114.9 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 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 locked in a kitchen drawer. LPA also observed toxin substances to be locked and inaccessible to clients in care secured (Annual Inspection continued on LIC809C) underneath the kitchen sink, garage and storage room. The fire extinguishers throughout the facility were fully charged. Kitchen appliances are operational during today's visit. 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. Facility provides activities based on resident interests and health conditions. The residents watch television, listen to music, play bingo, color, art and go for walks outside. There is also music therapy, and they love to sing. At the time of annual visit, residents were enjoying breakfast and visitors coming to see them. 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. 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 Licensee Ban Nguyen and a copy of this report LIC809, along with the 809-C, LIC858, and LIC859 were read and provided to the facility.