Routine inspection·April 4, 2025

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required comprehensive annual inspection. LPA met with Assisting Administrator, Elizabeth Zarate, was granted entry, and discussed the purpose for the visit. The facility is a Residential Care Facility for Elderly (RCFE) with a license capacity of (6), and a current census of (5). LPA conducted a general inspection of facility, which included, but was not limited to, the following: Operation/Physical Plant: Indoor and outdoor passageways were kept free of obstruction. The facility has no swimming pools or similar bodies of water. The facility has sufficient indoor activity space, art supplies, books, and board games for residents in care. Outdoor activity space is enclosed with a latching gate. LPA observed a bent butter knife in the passageway leading to the backyard gate. The facility is maintained at a comfortable temperature of 74 degrees F. Four (4) Resident bedrooms were furnished with beds, night stands, chairs, bed linen and lighting. One (1) bedroom was not inspected due resident being assisted by outside nurse. Resident bathroom equipment were operating properly and bathrooms were equipped with grab rails and slip mats. The hot water temperatures in the bathrooms measured at 110 degrees F. LPA observed in designated visitors bathroom cleaning solutions stored underneath an unlocked bathroom sink and on the bath tub. The facility is equipped with operating smoke detectors and carbon monoxide alarms, fully charged fire extinguishers, laundry equipment, and telephone service. The facility has posted in a common area Community Care Licensing complaint poster, Ombudsman poster, facility license, and evacuation plan. The facility staff schedule reflects 24 hours a day, 7 days a week staff coverage. Food Service: Kitchen and dining areas were maintained cleaned. Non-perishable and perishable food supply was sufficient for number of residents in care. Cups, plates, and utensils were sufficient for number of residents in care. The facility’s refrigerator and freezer were operating properly. **continued on next page** Health Related Services: The facility maintains record of resident’s medications and medications were centrally stored in a locked room and cabinet. Record Review : The facility has an emergency and disaster drill for review. The last emergency drill conducted with staff was on 02/27/25. Resident files reviewed had admissions agreements, physician’s reports, appraisals, emergency contact list, and care plans. Review of three (3) staff files reveals, Administrator's Raymond Chu did not have a current record of their administrator's certificate (expired in 2022) and did not have a health screening verifying Administrator's good physical health on file for review. Deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted were this report was discussed and copy provided with appeal rights to the Assisting Administrator at the conclusion of the visit.