Routine inspection·June 24, 2024

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's required - 1 year annual inspection. LPA met with Licensee Guili Xu and Administrator Wusheng Zhao. During visit, LPA toured the facility with Licensee to include the resident bedrooms, staff bedrooms, living room, office, kitchen, garage, and backyard. LPA observed the sheds in the backyard contains storage items. All fire exits routes are free and clear of obstruction. Facility temperature maintained at 76 degrees Fahrenheit. 3 staff and 1 live-in individual present are fingerprint cleared and associated to the facility. Facility has a carbon monoxide detector present. Fire extinguisher last serviced on 03/01/2024. Kitchen observed with at least 2 days worth of perishables and 7 days worth of non-perishable foods. Refrigerator temperature maintained at 51 degrees Fahrenheit. Licensee was advised. Freezer temperature maintained below 0 degrees. Items inside the refrigerator observed covered. During visit, Administrator adjusted the temperature control of the refrigerator which will take about 24 hours to adjust. Fruits observed in the dining room. Sharp objects (such as kitchen knives), disinfectants, and chemicals observed secured inside the same cabinet in the kitchen. LPA advised to separate the chemicals and kitchen knives to avoid cross contamination. Licensee states they normally store the chemicals in a separate storage space. Administrator immediately moved the chemicals to another secured location. Medications observed locked. Bathroom hot water temperature in the hallway maintained at 117 degrees Fahrenheit. The bathrooms contains accessible hygiene products. Based on review of resident records, 6 out of 6 resident's are not as risk if provided access to hygiene items. SEE LIC812-C. LPA observed 6 resident rooms contained adequate lighting, a bed, chair, night-stand and dresser. 6 out of 6 resident beds observed with half bed rails. Licensee was unable to provide the physician's order for half bed rails for 6 residents. During visit, Licensee obtained a physician's order for half bed rails for 5 residents. Licensee was advised. 3 out of 6 residents are under hospice care. The facility only has an approved hospice care waiver for 2 residents. Licensee was advised. LPA reviewed 6 resident records. Based on record review, 3 residents are noted to be bedridden. Licensee states 2 out of 3 resident's physician's report dated 06/13/2024 is incorrect and believes the residents are actually non-ambulatory. During visit, the Licensee contacted R1 and R4's doctor for clarification and obtained an order stating the 2 residents are non-ambulatory. Licensee was reminded of their approved fire clearance. Licensee states understanding. Licensee will ensure to update the resident's physician's report to reflect the correct ambulatory status. 6 out of 6 resident records contains an admission agreement, updated physician's report, TB result, updated appraisal/needs and services plan, consent forms, and personal rights. LPA reviewed 2 staff records contained a fingerprint clearance, 1st aid certification, TB result, and employee rights. 1 out of 2 staff members was recently hired as of May 2024. Licensee states the new staff is provided training but licensee was unable to produce the completed training documentation. Licensee was advised to ensure the training documentation is filled out for new staff. Licensee stated understanding. Facility has an emergency disaster plan. Flashlight, batteries and first aid kit observed. The last emergency drill was conducted on 03/15/2023. Licensee advised. LPA observed the facility has PPE supplies. Documents were obtained to include Administrator Certificates and Liability Insurance. LPA requested Licensee to submit the LIC500, Emergency Disaster Plan, and Infection Control Plan by 06/25/2024. Deficiencies were cited today per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with Licensee Guili Xu and a copy of the report and appeal rights were provided.