Post-licensing visit·June 18, 2025

On 06/18/2025, Licensing Program Analyst (LPA) Pang Lee made an unannounced visit to this facility to conduct a post required inspection. LPA Lee met direct care staff Imelda Panen and explained the purpose of the visit. Facility staff called to informed Administrator Erica Panen that CCLD was present. Administrator arrived at the facility approximately two hours later to assist the visit. The facility has a fire clearance to accommodate six non-ambulatory residents, including approval for one bedridden resident in room #3, and is licensed for two hospice waivers . LPA Lee was met by Ombudsman Byron Toliver. Together, LPA Lee, Ombudsman Bryon and Imelda inspected the physical plant, including but not limited to the kitchen, dining room, resident bedrooms and bathrooms, laundry room, garage, and outside courtyards, to assess compliance with Title 22 regulations. LPA Lee observed the facility was clean, odor-free, and in good repair . Resident bedrooms were properly furnished with appropriate bedding and lighting and were found to be sanitary. The fire extinguishers , smoke detectors, and carbon monoxide detectors were in good working condition. The exterior of the home was free of debris, and the emergency exit gate was functional and in good repair. The kitchen was clean and sanitary. LPA Lee observed adequate food supplies, including a seven-day supply of non-perishable food and a two-day supply of perishable food, both of which were accessible to residents. A review of records for Resident #1 (R1) indicated that R1 is both non-ambulatory and bedridden . This was confirmed through interviews with R1 and R1’s responsible party. However, it was discovered that R1 is currently housed in Bedroom #2 , which does not have fire clearance for a bedridden resident . The facility is only approved to house a bedridden resident in Bedroom #3 . Continued LIC 809-C LPA Lee reviewed two resident files and it was found to be complete. A medication review was also conducted for Resident #2 (R2). It was unclear what medications are currently prescribed to R2. Based on R2's LIC 602 Physicians Report, R2 needs assistance in these areas; however, R2 is able to manage own medications , administer own medications, and store their own medications . It was also learned that R2 stores part of R2's medications in their room, while the facility stores the remaining medications in a locked cabinet. Clarification is still needed regarding R2’s prescribed medications. LPA Lee will follow-up on this on complaint control # 27-AS-20250616145518. As a result of this post-licensing visit, the facility is not in compliance with Title 22 Regulation, and the deficiency can be found on the LIC 809-D page. The facility was also assess an immediate civil penalty. An exit interview was conducted, and a copy of these LIC 809 reports, LIC 809-D page, LIC 421 IM and Appeals rights were provided to the facility.