Health check·June 2, 2025

On 06/02/25, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to conduct a health and safety case management visit. The facility is on quarterly visit due to non-compliance concerns discussed during a Microsoft team meeting on 01/30/25. LPA Lee met with administrator Aliti Wagalala and explained the purpose of the visit. The census is 9 with 2 facility staff. LPA Lee and administrator toured the physical plant to ensure compliance with Title 22 regulations. LPA Lee observed 5 resident bedrooms, 2 resident bathrooms, common area, staff room, kitchen, laundry room and the courtyard. LPA Lee observed resident bedrooms to have necessary furniture and furnishings. Bedrooms were equipped with a bed, chair, dresser, and closet space. Bathrooms handrails and non-skid mats are in good repair. Fire extinguishers were up to date and fully charge. No emergency exits were obstructed. LPA Lee reviewed food supply to ensure that the facility had a 2-day perishable and 7-day nonperishable food supply. LPA observed laundry room where it was observed that detergent, laundry room and all cleaning supplies were locked and made inaccessible at this time. Knives were observed to be locked and made inaccessible. LPA requested to review 6 resident files and 3 out of 6 file was incomplete. Resident 1 (R1) was missing LIC 625 Needs and Services, Admission Agreement and LIC 613 Personal Rights. R2’s LIC 601 Emergency and Identification form is incomplete. R3 is missing LIC 601 Identification and Emergency, LIC 625 Needs and Services and LIC 603 Resident appraisal. LPA reviewed staff files and it was observed to be current with up to date. LPA Lee reviewed 3 resident medications, and it was accurate and complete. As a result of this case management visit, the facility is not in compliance with Title 22 Regulation, and the deficiency can be found on the LIC 809-D page. An exit interview was conducted with administrator Aliti and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility.