Routine inspection·December 11, 2024

Licensing Program Analysts (LPAs) Michael Tea and Fred Arias 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 caregivers Francis Ramirez Jimenez and Astrid Ojeda 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, with a hospice waiver for six. Currently there are four residents, of which one is on hospice during today's visit. LPAs reviewed four resident files and two staff files. Resident files and staff files contained all required documentation. Administrator Honglan Tran’s administrator certificate expires on July 30, 2026 but is not physically displayed in the facility. LPAs advised LE Nguyen that administrator certificate needs to be displayed in the facility. LPAs Tea and Arias along with the caregivers toured the facility at 2:39 PM. LPAs toured the physical plant, checked food service, and the first aid kit. The facility is a single-story home that consists of 4 resident bedrooms, 1 storage room, 2 bathrooms, living room, dining room, kitchen, and detached garage. LPAs 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 152.2 F degrees but warnings signs were posted in the restroom for the hot water. 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. LPAs observed sharps stored in a container and locked in the medication cabinet. LPAs also observed toxin substances to be locked and inaccessible to clients in care secured underneath the kitchen sink. Annual inspection continued on LIC809-C The fire extinguishers throughout the facility were fully charged. Kitchen appliances are operational during today's visit. LPAs toured the outside grounds and there is ample seating with shade in the backyard. LPAs observed emergency supplies, food and water in the storage room and garage. Facility provides activities based on resident interests. The residents watch television, listen to music, do puzzles, and play Monopoly. They like to go on walks in the morning. A physical therapist comes to the facility do exercise with them. They love to sing and dance. At the time of annual visit, residents were seen watching television and relaxing. LPAs reviewed medication storage and administration. Medications are stored in a locked cabinet in a staff area. Medications are being administered per physician order, but not properly documented. LPAs interviewed residents regarding their quality of care and spoke to staff present regarding care provided. The following deficiency 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.