Routine inspection·July 8, 2025

Licensing Program Analyst (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 a caregiver staff and explained the reason for the visit. Administrators (AD) Kristine Truong and Brenda Truong arrived shortly to assist with the visit. The facility is licensed for a capacity of six, approved for six non-ambulatory, with a hospice waiver of four. Currently there are six residents, and there are two on hospice during today's visit. LPA Tea reviewed six resident files and four staff files. Resident files contained most of the required documents, except four of the residents does not have updated physician’s report. Staff records met all requirements. The administrator certificate expires on January 17, 2026. LPA Tea along with staff toured the facility. LPA toured the physical plant, checked food service, and the first aid kit. The home is a one-story facility that consists of 5 resident bedrooms, 2 full bathrooms, living room, kitchen, dining area, and attached garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms 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 between 108.1 Fahrenheit degrees and 115.5 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 Annual Inspection continued LIC809C 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 secured in a kitchen drawer. LPA also observed toxin substances to be secured and locked and inaccessible to clients underneath the kitchen sink and garage. The fire extinguishers throughout the facility are fully charged. The facility’s last fire drill was conducted on January 27, 2025. Kitchen appliances are operational during today's visit. LPA observed emergency food and water supply in the kitchen and garage. There was not enough water for residents in case of emergency. LPA toured the outside grounds. There is a shaded patio area for residents to sit outside. The gates on both sides of the house are self-latching and operational. Facility provides activities based on resident’s personal preference and health condition and limitations. There are activities like coloring and reading provided for residents. There are group discussions, and an activities person comes to the facility from time to time. At the time of the visit, LPA observed residents watching TV and enjoying lunch. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet in the kitchen. Medications are being administered per physician orders. LPA advises facility needs to list PRNs on their centrally stored medications list. LPA interviewed clients regarding their quality of care and spoke to the staff present regarding care provided. Based on the observations made during today’s visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with Administrators Brenda Truong and Kristine Truong and a copy of this report LIC809, 809-C, LIC809-D, LIC858, LIC859 were read and provided to the facility.