Kun Bai Care #2 Home

1569.185 Fees for license... (a)(1)...After initial licensure, a fee shall be charged... annually... (b)(1)(F) A late fee that represents an additional 50 percent of... current annual fee when a licensee fails to pay... on or before the due date as indicated. This requirement was not me as evidenced by: Based on facility file review, the licensee did not comply with the section cited above by not ensuring the facility licensing fees were been paid to the Department by the due date which poses an immediate health and saftey risk to residents in care.

§1569.618 (a) The administrator designated... shall be present at the facility during normal working hours... shall be responsible for the operation of the facility when the administrator is temporarily absent from the facility. This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above by not ensuring that the facility Administrator is present at the facility during working hours as required which poses an immediate health, safety or personal rights risk to persons in care.

87309(a) ... [T]he licensee shall ensure that disinfectants, cleaning solutions,... sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Based on observation, facility staff did not ensure disinfectants, cleaning solutions, and sharp objects were not left unattended or outside of locked storage areas which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation and interview, the licensee did not comply with the section cited above in three (3) out three (3) resident bedrooms did not have a chair which poses a potential health, safety or personal rights risk to persons in care.

Based on interview and record review, the licensee did not comply with the section cited above in Resident #1 (R1) was not given their medication as prescribed which poses an immediate health and safety risk to one (1) out of four (4) residents in care.

Care of Persons with Dementia(c)(5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment.This requirement is not met as evidenced by Based on record review, the licensee did not comply with the section cited above by not ensuring that Resident1 have an annual medical assessment as required for dementia resident which poses an immediate health, safety or personal rights risk to persons in care.

Other Provisions(a) The administrator designated.. shall be present at the facility during normal working hours... shall be responsible for the operation of the facility when the administrator is temporarily absent from the facility.This requirement is not met as evidenced by Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that the Administrator's present at the facility during working hours as required which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, interview, record review)], the licensee did not comply with the section cited above by not ensuring that facility staffs are assisting Resident #1 (R1) with one (1) of R1's medication as evidenced of R1's medication was not given per R1's physician directions which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that the facility that cover injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three (3) million dollars ($3,000,000) in the total annual aggregate caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees which poses a potential health, safety or personal rights risk to persons in care.

Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that the Administrator's present at the facility during working hours as required which poses a potential health, safety or personal rights risk to persons in care.

Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that Staff #2 (S2) who'son duty and on the premises at all times have the required cardiopulmonary resuscitation (CPR) training and first aid training which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, interview and record review, the licensee did not comply with the section cited above by not conducting the required fire and earthquake drill at least quarterly which poses a potential health, safety or personal rights risk to persons in care.

Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that the emergency disaster plan was reviewed annually and signed by the Administrator or LIcensee which poses a potential health, safety or personal rights risk to persons in care.

Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that there's planned activities at the facility for the socialization of residents and not just watching television at teh living room which poses a potential health, safety or personal rights risk to persons in care.

Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that night lights were maintained in hallways and passages to non-private bathrooms which poses a potential health, safety or personal rights risk to persons in care.

Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that the observed one (1) scissor four antibiotic ointments in R1 and R2 bedroom, theb two (2) gallons of bleach, three (3) bottles of cleaning solutions, one bottle of laundry detergent in the garage and one (1) scissor in the hallway closet, were locked and not accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, interview, record review, the licensee did not comply with the section cited above by not ensuring that one (1) medication of Resident #2 (R2) has R2's physician authorization which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, interview and record review, the licensee did not comply with the section cited above by allowing Resident #2 (R2) with full bed rail and R2's not on hospice and no letter/waiver was submitted and approved by CCLD which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that there's a staff schedule to work the night shift as required for facility with dementia residents which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that Resident #2 (R2) have an annual medical assessment as required for dementia resident which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that the auditory device that alert staff to monitor exits are not in disrepair which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that the facilitgy has the required carbon monoxide detectorswhich poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, interview and record review, the licensee did not comply with the section cited above by admitting Resident #2 (R2) at the facility on 03/29/2023 and not ensuring that R2 physician report has physician signature and signature date which poses an immediate health, safety or personal rights risk to persons in care.

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on observation, and interview, the Licensee did not comply with the section cited above by not ensuring that residents centrally stored medications are kept in a safe and locked place that is not accessible to residents in care which pose immediate health, safety and personal rights risks to residents in care.

87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Based on observation, interview and records review, the Licensee did not comply with the section cited above by allowing Resident #3 (R3) to have full bed rail at the facility which pose potential health, safety and personal rights risks to resident in care.

87309 Storage Space (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. (1) Storage areas for poisons, and firearms and other dangerous weapons shall be locked. This requirement is not met as evidenced by: Based on observation, and interview, the Licensee did not comply with the section cited above by not locking the multiple bottle of cleaning solutions, and chemicals under the kitchen sink making it accessible to residents in care which pose immediate health, safety and personal rights risks to residents in care.

87458 Medical Assessment a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Based on observation, interview and records review, the Licensee did not comply with the section cited above by not ensuring that Resident #3 (R3) has a completed Medical Assessment by R3's Physician prior to acceptance as a resident at the facility as evidenced of R3's Physician Report on file is not complete due to missing Physician signature which pose immediate health, safety and personal rights risk to residents in care.

87309 Storage Space (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Based on observation and interview, the Licensee did not comply with the section cited above by not storing the five (5) knives observed in the kitchen cabinet where it's inaccessible to residents in care which pose immediate health, safety and personal rights risks to residents in care.

HSC 1569.618 Administration and management of residential care facilities; substituted qualifications; employee scheduling (a) The administrator designated by the licensee pursuant to paragraph (11) of subdivision (a) of Section 1569.15 shall be present at the facility during normal working hours. A facility manager designated by the licensee with notice to the department, shall be responsible for the operation of the facility when the administrator is temporarily absent from the facility. This requirement is not met as evidenced by: Based on observation, interview and records review, the Licensee did not comply with the section cited above by not having an Administrator present during working hours at the facility which pose potential health, safety and personal rights risks to residents in care.

Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having staff with the required training/training documents which poses an immediate health, safety, or personal rights risk to persons in care.

Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having a non-slip mat in the bathroom shower which poses a potential health, safety, or personal rights risk to persons in care.

Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having staff with the required training/training documents which poses an immediate health, safety, or personal rights risk to persons in care.

Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having the required documents in the resident’s facility file which poses a potential health, safety, or personal rights risk to persons in care.

Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having a first aid kit which poses a potential health, safety, or personal rights risk to persons in care.

Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having a first aid manual which poses a potential health, safety, or personal rights risk to persons in care.

Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by leaving medication unlocked in the refrigerator and by leaving unlocked medication in a zip lock bag on the desk in the living room area which poses an immediate health, safety, or personal rights risk to persons in care.

Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by storing a resident’s medications in a plastic weekly container box which poses an immediate health, safety, or personal rights risk to persons in care.

Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having the required documents in the resident’s facility file which poses a potential health, safety, or personal rights risk to persons in care.

Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having sheets and mattress covers on the resident’s beds which poses a potential health, safety, or personal rights risk to persons in care.

Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having the administrator present in the facility during normal working hours which poses a potential health, safety, or personal rights risk to persons in care.

Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having the required staff present in the facility which poses an immediate health, safety, or personal rights risk to persons in care.

Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having a staff present in the facility with CPR training which poses an immediate health, safety, or personal rights risk to persons in care.

Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having staff with the required training/training documents which poses an immediate health, safety, or personal rights risk to persons in care.

Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having staff with the required training/training documents which poses an immediate health, safety, or personal rights risk to persons in care.

Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having the required resident documents which poses an immediate health, safety, or personal rights risk to persons in care.

Basic laundry service (washing, drying, and ironing of personal clothing).The facility did not meet this requirement while the water was turned off. The facility lacked access to water to adequately clean clothing and bedding. This poses a risk to the health and safety of residents in care.

The facility shall be clean, safe, sanitary and in good repair at all times...The facility did not meet this requirement while the water was turned off. The facility lacked access to water to adequately clean the facility. This poses a risk to the health and safety of residents in care.

The admission agreement shall specify which of the basic services are desired and/or needed by, and will be provided for, each resident. The facility did not meet this requirement while the water was turned off as evidenced by residents not having access to water for bathing. This poses a risk to the health and safety of residents in care.

False Claims: No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. The Licensee has failed to meet this requirement as evidence that Licensee provided LPA with a false claim that she issued R1's responsible party a refund

A refund of any fees paid in advance ... shall be issued ..The facility has failed to issue a refund to R1 as per their admission agreement.

The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency. Such request shall explain the need for disclosure. The licensing agency reserves the right to reject any financial report and to request additional information or examination including interim financial statements. Based on interview and record review, the licensee did not comply with the section cited above by not providing all the requested documents to complete a financial audit and did not prove that there is a financial plan in place which poses an immediate health, safety, or personal rights risk to persons in care.

(f) The following shall be stored inaccessible to residents with dementia:(1) Knives… and other items that could constitute a danger to the resident(s).This requirement is not met as evidenced by:The licensee failed to lock away the knives which poses an immediate risk.

Care of residents with dementia:(j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement is not met as evidenced by: The licensee failed to ensure door chimes to all exits are operating.

(f) The following shall be inaccessible to residents with dementia: (2) … toxic substances such as … cleaning supplies and disinfectants. This requirement is not met as evidenced by: The licensee failed to lock away the chemicals and detergents which poses an immediate risk.

Maintenance and Operation(a)The facility shall be clean... sanitary and in good repair at all times.This requirement is not met as evidenced by: The Licensee failed to repair the smoke alarm detector hanging in the kitchen ceiling which poses a potential risk to residents in care.

87411. Personnel Requirements – General. (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.. Based on interview and observation, the licensee did not comply with the section cited above evidenced by staff not being able to adequately communicate with residents due to language barrier which poses an immediate health, safety or personal rights risk to persons in care.

87608. Postural Supports. (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. Based on interview and observation, the licensee did not comply with the section cited above evidenced by tying a resident’s legs, a residents waist, and a residents wheelchair to a couch using straps to restrict movement in a wheelchair which poses an immediate health, safety or personal rights risk to persons in care.

87555. General Food Service Requirements. (b)The following food service requirements shall apply: (7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided. Based on interview and document review, the licensee did not comply with the section cited above evidenced by not following the resident’s medical special diet which poses an immediate health, safety or personal rights risk to persons in care.

87211 (a) (1) REPORTING REQUIREMENTSA writen report shall be submitted to the licensing agancy and to the person responsible for the resident within seven days of occurrance...This requirement was not met as evidnced by: Adminstrator Na Zhao confirmed with LPA Prieto that an incident report as not send nor was the Licensing office notified of the incident that occurred on 06/23/21

87303. Maintenance and Operation. (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. Based on interview, observation, and record review, the licensee did not comply with the section cited above by not have running water in the facility which poses an immediate health, safety, or personal rights risk to persons in care.

87355. Criminal Record Clearance. (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing, or volunteering in a licensed facility:(1) Obtain a California clearance or a criminal record exemption as required by the Department or Based on observation, interview, and record review, the licensee did not comply with the section cited above by allowing S1 to work at the facility for one (1) day without a criminal background clearance which poses an immediate health, safety or personal rights risk to persons in care.

Based on interviews, licensee failed to ensure S2 and S3 were fingerprinted and associated to the facility prior to employment. This is an immediate health and safety risks to the resident in care..

87202 (a)(2) FIRE CLEARANCEAll facilities shall maintain a fire clearance approved by the city, county, or city and county fire department. Bedridden person.This regulation was not met as evidenced by: LPA observed and interviewed resident #2 who is a hospital bed and states R2 is bedridden. Interview with administrator states R2 arrived to facility with a bedridden diagnosis. License does not state that facility is cleared for bedridden clients. This poses an immediate health and safety risk to client in care.

87405 (a) Administrator – Qualifications and Duties. All facilities shall have a certified administrator with enough freedom from other responsibilities and a sufficient number of hours on the premises to give adequate attention to the administration of the facility. This regulation was not met as evidenced by: LPA observed an administrator certificate for Ms Zhao with an expiration date of 03/26/2021. Ms Zhao states that she does not have a current administrator certificate. This poses a risk to clients in care.

87411 (a) - PERSONNEL REQUIREMENTS GENERALFacility personnel shall at all times be sufficient in numbers and competent to provide the services necessary to meet residents needs.This requirement was not met as evidenced by: Based on interviews, residents #1 and #2 were left at the facility unattended by staff on 06/12/21 for approximately 30 minutes until staff returned to the facility, which poses an immediate health and safety risk to the persons in care