Routine inspection·August 7, 2025

On August 7, 2025, at 2:00 PM, 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 met with Caregiver Emma Tablang. A phone call was made to Assistant Administrator (ASAD) Catherine Hsi who explained Administrator Thi Nhu Mai Do was not available because they will be away from the facility from August 4, 2025, to August 20, 2025. ASAD Hsi stated they could not attend today’s visit and CG Tablang could sign on behalf of the facility. The facility is licensed to operate for five (5) non-ambulatory residents, of which one may be bedridden and have a hospice waiver for six (6) residents. The facility is a two-story building located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, two bedrooms on the second floor, four (4) bathrooms, living room, common area, dining area, office area, kitchen, attached 2-car garage, and an outside covered patio area. LPA Kim toured indoor and outdoor of the physical plant with CG Tablang. There are no obstructions or bodies of water on the premises. 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. All bedrooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be clean and operational. Bathroom water temperature measured between 132.0 degrees F and 132.9 degrees F. A comfortable temperature of 78 degrees F was maintained in the facility. Evaluation Report Continues on LIC 809-C LPA Kim observed the facility to be sanitary and 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. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. LPA observed the front left burner was not in working order. Emergency food, water, and supplies are stored in the kitchen pantry and in the garage. 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). The facility conducts Fire/Safety Drills quarterly and was last conducted on May 12, 2025. A working telephone (714-594-3270) remains available. Smoke detectors and carbon monoxide detectors were operable. The fire extinguisher was mounted in the kitchen. LPA Kim conducted an audit of four (4) residents (R1-R4) files, and 2 (2) staff (S1-S2) personnel files, and medication and medication administration records. LPA observed S1 and S2 did not have any training hours for 2025. LPA conducted interviews for two (2) residents and two (2) staff. Based on today’s visit, deficiencies are being cited as per Title 22 Division 6 Chapter 8 of California Code of Regulations (CCR). LPA observed the water temperature for bathroom 1 measured at 132.0 degrees F and bathroom 2 measured at 132.9 degrees F. LPA observed front left burner on the stove did not light unassisted. LPA observed S1 and S2 did not have any 2025 training hours completed. An exit interview was conducted and a copy of this report, LIC811, and appeal rights were provided to Caregiver Emma Tablang.