Pre-licensing visit·October 28, 2024

Licensing Program Analysts (LPAs) Nancy Guillen, Brandon Lopez and Rose Ruppert made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPAs met with Administrator (AD) Diane Nguyen and Licensee Khanh Ton. An application to operate a Residential Care Facility for the Elderly (RCFE) for six non- ambulatory residents with six residents approved for hospice was received by Community Care Licensing (CCL) on February 13, 2024. The facility is a one-story house with six resident bedrooms, one staff bedroom, six bathrooms, two living rooms a,dining room, kitchen and an unattached staff room in the backyard. LPAs observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall near the bulletin boards in the second living area. There is a backyard with an exit gate on each side of the house. There is a shaded seating area and LPAs did not observe any obstacles or hazards in the backyard. At 1:30 PM LPAs toured the facility and observed each of the six private residents bedrooms had the required furnishings. Bed rail orders were on file and each room had a lamp, chest of drawers, chairs and linens. LPAs tested hot water temperatures in six of six resident bathrooms. The hot water temperatures measured between 116.7 to 127.4 degrees Fahrenheit. The following faucets measured as follows: Bathroom #1 was 124.5 degrees, Toilet #1 was 121.2 degrees, Toilet #3 was 125.9 degrees and Toilet #2 was 127.4 degrees Fahrenheit. Bathroom #2 is a staff bathroom and does not require grab bars in the shower and Bathroom #3 does not have a grab bar in the shower and is in a resident bedroom. LPAs observed Bedroom #7 did not have an auditory exit alarm. The sliding glass door handle exit into the backyard was in disrepair. There are push pins on the wall next to the residents bed in Bedroom #1 which Administrator immediately removed. LPAs observed razors in three of six bathrooms and asked licensee to remove them and store them in a secured area. (Continued on LIC 809-C) Continued from LIC 809) LPAs inspected the physical plant and observed the centralized smoke alarm and carbon monoxide detector were operational. The fire extinguishers were charged and were serviced on February 15, 2024. LPAs inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPAs observed pantry and canned goods expiration dates and all were not expired. LPAs observed sharps and knives were in a locked drawer and chemicals were secured under the sink. The medication storage and resident files were locked and a First Aid kit was observed with the required elements including a First Aid Manual. LPAs confirmed that administrator has a current administrator certificate which expires on August 19, 2026. LPA will re-schedule a follow-up pre-licensing visit for this facility. Administrator and Licensee will adjust the hot water temperatures in three of six bathrooms to be within 105 -120 degrees Fahrenheit. Administrator will place grab bars in bathroom #3. An alarm was installed in Bedroom #7's exit door during our visit. An exit interview was conducted and a copy of this report was provided to the Administrator.