Routine inspection·February 18, 2025

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with staff and was later joined by Administrator and Licensee Angela Zhang who were informed of the purpose of the visit. At the time of the visit there was (3) staff and (5) residents present. The facility is a one story home with (4) bedrooms and (2) bathrooms for residents and (1) staff bedroom. No pools or firearms are being kept at the facility. LPA observed the following: Infection Control: The LPA observed the facility restrooms and kitchen had hand hygiene supplies. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA did not have an infection control plan at the time of the visit, there a citation is being issued. Physical Plant: LPA observed the resident bedrooms. Physical plant, floors, windows, and doors were observed and fixtures and furniture were in good were present. The outdoor area was observed to be free of hazards. The sharp and dangerous objects were observed to be locked and inaccessible to clients. The smoke detector and carbon monoxide was operational. The hot water temperature was initially read at 110F in a resident restroom. Based on record review Resident #2 (R2) is bedridden and the licensee is approved for non-ambulatory residents only. LPA observed R1's room does only has (1) exit and does not have a side door leading to the emergency route. Therefore, the licensee is being cited for not having the appropriate fire clearance. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Care & Supervision / Administration: Adequate staff are present for the supervision of clients during the visit. Required postings were found in the facility. The current administrator provided proof of their Administrator's Certificate. Based on staff interview it was revealed that only (1) staff and (1) volunteer are working at the facility at this time, and (1) administrative staff comes to supervised the staff's work but does not assist with direct care needs. Staff and Licensee revealed there is no awake staff at night, when assistance is needed residents call on the staff. The licensee was interviewed who stated they do assist residents and are present at the facility every day including at night. However, the licensee did not have a staff schedule at the time of the visit to verify the staff schedules. Therefore, the licensee is being cited for not having an up to date staff schedule reflecting coverage at all times. Record Review and Resident/Staff Files: LPA reviewed (1) staff file and conducted an interview with staff which revealed the training was received from their previous employment. The licensee revealed they would have to document the hours of training provided. The licensee is being cited for not having documentation of staff training. LPA was unable to review (2) of (3) staff files due to them not being available at the time of the visit. Staff 1 (S1) did not have a file at the time of the visit. The licensee is being sited for not having staff file present for review. Resident #3 (R3) did not have a SAFEGUARDS FOR PROPERTY/VALUABLES form in their file. Therefore, the licensee is being cited for not having this document at the time of the visit. Resident #4 (R4)'s Needs and Services Plan revealed the licensee is signing as the R5's legal representative. Interview with licensee revealed they had not sent the form to the responsible party for signature and review. Therefore, the licensee is being cited for not having a meeting with the resident's representative. Health Related Services/ Incidental Medical Services: All resident medications were locked. LPA reviewed resident medication records which revealed medication had required labeling and centrally stored lists for all residents. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. The licensee stated they conducted their last fire drill a year ago which did not meet the licensing requirements. Therefore a citation was issued for not having completed a fire drill. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies and first aid kit with all required items. An exit interview was conducted where this report was reviewed along with the deficiency pages and appeal rights. *LPA was present at the facility from 9:00am to 11:50am, then returned to the facility from 1:10pm to 3:45pm in order to prepare the report.