Routine inspection·March 28, 2025

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensee Lilia Opalec. According to the facility’s license, the facility has a maximum capacity of six (6) residents, of whom all may be ambulatory or non-ambulatory, but none may be bedridden. The facility also has a CCLD-approved waiver for up to two (2) residents on hospice care. According to LIC602 Physician’s Reports, care/hospice records, staff interviews, and LPA observation: During this annual inspection, there were a total of three (3) residents in care, of whom all were non-ambulatory, per their respective doctors. Two (2) of these residents were also under hospice care. The facility’s license did not include endorsements for delayed-egress doors or secured perimeter, and neither of these were present. During this inspection, LPA interviewed all residents in care and multiple staff. LPA reviewed the care records for all residents and the personnel and training files for all active staff. LPA also toured the interior and exterior of the facility and inspected all common areas and bedrooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were working. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. [CONTINUED ON LIC 809-C, 1 of 2] [CONTINUED FROM LIC 809] The facility’s ambient internal temperature was complaint at 70 F. Hot water at taps accessible to residents were compliant in temperature: Kitchen Sink was 111.7 F, Bathroom #1 Sink was 105.1 F, Bathroom #2 Sink was 114.8 F, and Bathroom #3 Sink was 108.3 F. Refrigerators and Freezers used to preserve perishable food were also complaint in temperature. There were at least (2) days of perishable food and at least seven (7) days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. No fireplaces or pools/bodies of water observed on the premises. There were no open-faced heaters accessible to residents. Smoke detectors, carbon monoxide detector, night lights, and facility telephone were all working. Confidential records were stored in locked areas. Required licensing postings were observed in visible areas of the facility. Per the Licensee, no firearms or ammunition were kept at the facility. Licensee presented proof of current business liability insurance. During the facility tour, LPA observed, and manager interview confirmed: The facility’s fire extinguisher had not been serviced within the last twelve (12) months, as required. Also, the facility’s manual fire alarm pull station had not been serviced within the last twelve (12) months, as required. (During today's visit, a professional inspector was brought in to service the extinguisher and pull station). Four (4) of the facility’s five (5) flashlights were non-working, and it took staff over ten minutes in broad daylight to finally locate and present the one working flashlight to LPA. Staff did not have spare batteries needed to remedy the other flashlights during the visit. While the facility was equipped with internet service, Licensee did not ensure that a device “equipped with microphone and camera functions” (such as a computer, smart phone, or tablet) “that can support real-time interactive applications” and “videoconferencing technology,” remained at the facility and was “dedicated for resident use.” During review of client records, LPA observed, and manager interview confirmed: Licensee did not possess an LIC602 Physician’s Report (or equivalent Medical Assessment) for Resident #1 (R1), which was required before R1 moved in. [See LIC 811 Confidential Names List for a description of select person identifiers used in this report.] Also, the LIC602 Physician’s Report for Resident #2 (R2) was not signed by their respective doctor. [CONTINUED ON LIC 809-C, 2 of 2] [CONTINUED FROM LIC 809-C] R1 and R2 were both patients under the same hospice agency/company. However, Licensee did not maintain a copy of R2’s Hospice Plan of Care at the facility, as required. Hospice agency personnel did not provide training to the four (4) active direct care staff of the facility on R1’s specific care needs. While hospice agency personnel trained caregiver Staff #1 (S1) on R2’s care needs, they did not train the other three (3) active direct care staff of the facility on such. (Regulation required Licensee to ensure that the hospice agency provided “training specific to the current and ongoing needs of the individual resident receiving hospice care…before hospice care to the resident begins.”) During review of training records, LPA observed, and manager interview confirmed: Licensee did not have proof that direct care staff had been trained on Personal Protective Equipment (PPE) within the last year, as required. While Licensee performed multiple disaster drills over the past year, they fell short of the required frequency of one drill per shift, per quarter, as required by regulation. The completed drills also did not “[take] into account different emergency scenarios,” as required by regulation. Six (6) deficiencies were cited per California Code of Regulations, Title 22, and two (2) deficiencies were cited per California Health and Safety Code (refer to the LIC809-D pages). Plans of Correction were jointly developed with the Licensee. LPA issued one (1) Technical Violation (TV) regarding submitting documents to CCLD to update the facility Administrator on record (refer to the LIC9102-TV page). LPA also issued Technical Assistance (TA) regarding refresher training on Mandated Reporting requirements for staff (refer to the LIC9102-TA page). An exit interview was conducted with Licensee Lilia Opalec, to whom a copy of this report, the LIC 809-D pages, the LIC9102-TV page, the LIC9102-TA page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today's visit.