Routine inspection·December 2, 2025

Licensing Program Analysts (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. Facility is licensed for six non-ambulatory residents, with a hospice waiver for six. Currently there are six residents, of which one is on hospice during today's visit. LPA reviewed six 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. The last disaster drill was conducted on December 1, 2025. LPA Tea and caregivers 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 4 resident bedrooms, 1 storage room, 2 bathrooms, living room, dining room, kitchen, and detached 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 89 F degrees, which was too low. The water boiler was not working properly. The staff explained that in the morning it was working fine. 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 stored in a container and locked in the medication cabinet. LPA also observed toxin substances locked and inaccessible to clients (Annual inspection continued on LIC809-C) in care secured underneath the kitchen sink, storage shed, and garage. The fire extinguishers throughout the facility were fully charged. Kitchen appliances are operational during today's visit. There was a little trouble with the kitchen stove burners, but the staff were able to turn all the burners on. LPA suggested that kitchen stove will probably need to be replaced. LPA toured the outside grounds and there is ample seating with shade in the backyard. LPA observed emergency supplies, food and water in the storage room and garage. Facility provides activities based on resident interests and physical condition. The residents watch television, listen to music, do puzzles, and play Monopoly. They like to go on walks in the morning. The residents love to sing. At the time of annual visit, residents were watching television and enjoying their early dinner. 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 deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with the facility, and a copy of these reports were given to the facility along with a copy of the LIC 858; 859;809-D, and Appeal Rights.