Routine inspection·April 28, 2026

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry Tsunghsien Yu, Caregiver. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Resident record review began- Two (2) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is meeting documentation requirements. Employee records review began- Two (2) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and current; expires 05/29/2028. Corporation or LLC is active and in good standing. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 116.0 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the garage. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. (Continued on LIC809, Page 2) (Continued from LIC809, Page 1) Laundry facilities and a cabinet is present for storing laundry soap and other chemicals in the laundry room. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. Food Service- Food supply meets the of one week supply of nonperishable and 2-day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized. LPA made observations throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation, and the structure remains unchanged according to the approved floor plan. LPA learned that one (1) caregiver is a live-in staff occupying resident room #5 that is designated for a resident. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers are tested or replaced annually and were last done so on 04/12/206. The facility conducting emergency disaster drills quarterly; last done 4/3/2026. Corporation is active and in good standing. Based on the information received during this visit today, zero (0) deficiency is being cited per Title 22, Division 6 of The California Code of Regulations. This report was reviewed with Jason Lin, and a copy provided at the time of the exit interview. LPA has requested updates to the following documents to be submitted to the CCL by 05/5/2026: LIC200 with updated sketch for changes to the floor plan, LIC308, LIC 500, LIC 610, liability insurance. *LPA was away from the facility from 12:50-1:50 PM