Routine inspection·July 9, 2024

On 07/09/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced annual inspection visit. LPA met with licensee/administrator Josephine Lee Wong and explained the purpose of today's visit. There are multiple staff and all 40 residents are present. LPA was allowed entry into the facility. This is a multilevel facility with a waiver for five hospice residents of which three residents are on hospice at time of this visit. Residents reside on the upper two floors while the entire ground floor is the communal space, dining room, kitchen, and lobby of the facility. The physical plant was toured inside and outside to ensure the safety of the residents. LPA observed the facility kitchen which is clean and observed appliances are in good repair. Knives are stored and locked in the kitchen behind a locking main door. Medications are observed to be locked in a medication room/office on the ground floor. Perishable and non-perishable food items are observed as in place and plentiful. First aid kit is observed as complete with required items. LPA observed that there are multiple fire extinguishers through out the facility in place inspected 07/03/24, smoke detector/carbon monoxide detectors are observed in place through out the facility, and central heating/cooling system. The facility is also fully equipped with fire sprinklers. PPE and additional staff supplies are observed in storage areas on the ground floor. Laundry area is observed as fully operational located behind locked doors on the ground floor. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Last emergency/disaster drill was conducted on 06/17/2024. Water temperature was measured at 115F on both the first floor and second floor in resident common full bathrooms. Shower floor use non-skid mat when shower is in use. Both resident levels of the facility have three common full bathrooms. Some of the larger shared rooms at the end of each floor have full bathrooms as well. LPA observed resident rooms at random and all appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. Resident linen supplies are observed as in place as well. Resident incontinence supplies are stored in each residents room for their use. Facility toxic and cleaning supplies are in locked closets on the ground floor. Continued on next page... Page 2 LPA reviewed 4 resident files and also reviewed 4 staff files on this day. Per resident files reviewed they are current. Per staff files reviewed all files were current with training and CPR/First Aid. P&I is not handled by the facility. Client medications are inspected and are current including facility medication administration records. Administrator certificate is observed as current expiring on 11/24/2025. Infection control plan is current as of 07/01/2023. As of today's inspection the infection control plan is current with no changes. No citations issued on this day. Report is reviewed with Josephine Lee Wong and a copy is provided.