Routine inspection·April 1, 2025

On April 1, 2025, at 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Caregiver (CG) Anna Aquino. Administrator (AD) Shelly Yamashiro and Licensee Kelly Ho arrived at the facility and LPA Kim explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents and has a hospice waiver for six (6) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, two (2) bathrooms, living area, den kitchen, outdoor covered patio, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with CG Aquino. There were no bodies of water or obstructions in the facility. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were clean. The water temperature measured at 134.6 degrees F to 137.4 degrees F. A comfortable temperature of 75 degrees F was maintained in the facility. LPA Kim observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food both were available and maintained properly. Emergency food, emergency water, and emergency supplies are stored in the garage. The smoke detectors and carbon monoxide detectors were operable. A working telephone (714-463-4194) remains available. Last emergency drill was conducted on April 1, 2025. First aid kit is maintained and contains all the necessary elements. Evidence of Liability insurance was effective from April 24, 2024, to expiration on April 24, 2025. LPA Kim conducted an audit of resident files (R1-R5), staff files (S1-S6), and medication and medication administration record. LPA Kim conducted two (2) staff interviews and two (2) resident interviews. Deficiencies were cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). LPA observed S2-S6 annual 20-hour training for 2025 were not available, LPA Kim observed a partition in the den where there is a bunkbed where staff sleep in, and LPA Kim observed water temperature for bathroom 1 and bathroom 2 measuring from 134.6 degrees Fahrenheit to 137.4 degrees Fahrenheit. Technical violations were cited during this visit. An exit interview was conducted, and a copy of this report and appeal rights were provided to Licensee Kelly Ho.