Routine inspection·March 21, 2025

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. At around 1:10 PM, LPA Tea was greeted and granted entry into the facility by Administrator (AD) Dennis Bui and explained the reason for the visit. Administrator (AD) Kevin Dinh arrived shortly to assist during the visit. Facility is licensed for six non-ambulatory residents, with an approved hospice waiver for six, and one maybe bedridden in Room #3. Currently there are no residents in care during today's visit. The administrator hopes to have residents for the facility during this year once the facility is approved for the Assisted Living Waiver (ALW) program. LPA Tea along with the Administrator toured the facility at 1:20 PM. LPA toured the physical plant, checked the first aid kit. The facility is a two-story home that consists of three resident bedrooms that will be shared, two full bathrooms, living room, dining room, kitchen and garage on the first floor. The second story is only for staff, where there is a loft and bedroom and full bathroom, no residents will reside there. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms to be operational. Door alerts were not working. Administrator will contact the alarm security company and have them fix it. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets worked properly and water faucets were a little bit loose. The grab bars were secure, and shower was free of mold/mildew. Water temperature measured around 112.2 Fahrenheit 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. Kitchen appliances are operational during today's visit. Sharps are locked and stored in a secured drawer in the kitchen. LPA also observed toxin substances inaccessible to clients in care, locked and secured underneath the stove. The fire extinguisher is fully charged in the kitchen. LPA toured the outside grounds and there is ample seating with shade. There are two exit gates that are self-latching and operational on both sides of the house. The backyard has a pool that is gated. Continuation of the annual report on LIC809-C No resident files were reviewed, and interviews were not conducted as there are no residents living at the facility. There were no health and safety concerns observed during today's visit. 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 Administrator Dennis Bui and a copy of this report LIC809, 809-C, 9102TV was read and provided to the facility