Inspection visit

Routine inspectionOctober 10, 2023

KUN BAI CARE #2 HOMELicense 33188082216 citations on this visit

16 citations recorded

Inspector’s narrative

What the inspector wrote

Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with Volunteer/Non-Client Resident Jair Melgarejo Martinez was granted entry to the facility. Administrator Brandon Marquez-Gutierrez arrived at the facility after LPA made a phone call to the licensee. At the time of the visit there was one (1) staff present, one (1) Volunteer/Non-Client Resident present, and three (3) residents present. The facility is a four (4) bedroom, two (2) bathroom home with a kitchen/dining area, living room, and attached garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory residents and the current census is three (3) residents. LPA was accompanied by Administrator to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. The resident’s (R1, R2, & R3) bedrooms did not have sheets and mattress covers on their beds. The shower in R2 and R3’s bedroom did not have a non-slip mat on the shower floor. Deficiencies will be issued for the sheets, mattress covers, and non-slip mat. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathroom to be at 109.7 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, labor laws, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a cabinet with the majority of the resident’s medications locked in the living room area. LPA found one Ziplock bag with two (2) pills inside of it laying on the desk in the living room area. LPA also found unlocked medication in the refrigerator. The facility is storing R1’s medications in a plastic weekly container instead of the original prescription container from the pharmacy. The facility will be issued deficiencies for medication issues. The facility does not have first aid kit and a first aid manual. The facility will be issued deficiencies for not having the required first aid kit and manual. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: The facility does not have an administrator and or a manager present in the facility enough hours to appropriately manage the facility. The facility does not have facility manager. The facility does not have a designated person who can manage the facility during the absence of the administrator. The administrator is only at the facility every other (5) days due to managing a total of five (5) facilities. The facility will be issued deficiencies for the supervision issues. The licensee is also hiring staff as volunteers and listing them as Non-client residents on the CDSS Guardian system. Record Review: LPA reviewed three (3) resident files for admission agreements, updated physician reports, and needs and services plans. The files were missing physician’s reports, admissions agreements, and preadmissions appraisals. The facility will be issued deficiencies for the resident record issues. LPA reviewed three (3) staff files/volunteer files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA found that two (2) of the three (3) staff do not have CPR trainings, staff are not properly trained in medication, dementia care, and basic trainings required for an RCFE. The facility will be issued deficiencies for the staff training and record issues. Medications/MARs records were audited and appeared to be dispensed appropriately by staff members. Based on the observations made during today’s visit, sixteen (16) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D forms, and appeal rights were discussed and provided to Administrator Brandon Marquez-Gutierrez

Citations

16 citations recorded^*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

1569.618(a)Type B
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.
1569.618(b)Type A
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.
1569.618(c)(3)Type A
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.
1569.625(b)(1)Type A
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.
1569.625(b)(2)Type A
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.
1569.625(c)(4)Type A
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.
87303(e)(5)Type B
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.
87307(a)(3)(C)Type B
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.
87411(c)(1)Type A
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.
87456(a)(2)Type B
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.
87465(a)(8)Type B
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.
87465(a)(8)(A)Type B
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.
87465(h)(2)Type A
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.
87465(h)(5)Type A
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.
87506(b)(15)Type B
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.
87458(a)Type A
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.

FAQ · About this visit

Common questions about this visit

What happened during the October 10, 2023 inspection of KUN BAI CARE #2 HOME?

This was a inspection inspection of KUN BAI CARE #2 HOME on October 10, 2023. 16 citations were issued: 9 Type A (serious) and 7 Type B.

Were any citations issued to KUN BAI CARE #2 HOME on October 10, 2023?

Yes, 16 citations were issued (9 Type A, 7 Type B). The first citation was for: "Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced..."

What type of inspection was this?

This was a inspection inspection. inspection inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLD View original report

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Data from CCLD public records. Last updated May 25, 2026. If you believe any information is inaccurate, report it here.

Routine inspection·October 10, 2023