Routine inspection·August 21, 2025

On 08/21/2025, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with administrator Hidenori Seki and designated staff Harue Seki and explained the purpose of the visit. Designated staff Harue assisted with today’s visit. Administrator certificate # is 7004855740 and will expire on 06/19/2026. The current census is 5 with 3 facility staff. This facility is a single story building licensed to serve six (6) non-ambulatory residents. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Lee observed the facility to be free of odor, clean and in good repair. LPA Lee observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA Lee toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 108.7 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars in the resident bathroom were observed to be stable and in good repair at this time. LPA Lee observed 4 out of 4 resident bathrooms did not have non-slip mats. Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in the kitchen and was last serviced on 04/25/2025. LPA Lee observed the facility has a has a public telephone in the common area and the facility has the required posters posted. CONTINUED LIC 809-C The facility thermostat was observed at 77 degrees Fahrenheit. LPA Lee observed toxins located in the outside storage cabinet kept locked and inaccessible to residents. LPA Lee observed sharp knives kept locked in the kitchen cabinet and inaccessible to residents. LPA Lee reviewed 3 out of 5 residents' Medication Administration Records (MARs), along with the medications stored in the residents' medication boxes and found them to be incomplete. LPA Lee observed 1 out of 3 residents had a PRN medication without a physician’s order. During today’s visit, designated staff Haure contacted the resident’s physician, confirmed that the medication had been prescribed, and requested a copy of the physician’s order. The first aid kit was checked and contained the required components. LPA Lee requested resident and staff files for review. LPA Lee reviewed 5 out of 5 resident files and they were complete. LPA Lee reviewed 3 staff files, and it was incomplete. 3 out of 3 staff files did not have current first aid/CPR in file. 1 out of 3 staff files did not have any current training verification in the file. The following documents will be emailed to LPA Lee @ pang.lee@dss.ca.gov by 08/29/2025 end of day 5:00 PM: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) LIC 500 Current Personnel Report As a result of this annual 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 designated staff Harue Seki and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility.