Correction check·August 4, 2025

On 08/04/2025, Licensing Program Analyst (LPA) Kiran Jain arrived at the facility to conduct a Plan of Correction (POC) visit. Upon arrival, LPA met with the Licensee, Fe Hilario and disclosed the purpose of the visit. The Licensee informed the LPA that there were five (5) residents in care and three (3) staff members present at the time. The Licensee accompanied the LPA during the inspection. On 07/08/2025, the LPA conducted a Required 1-Year Annual inspection at the facility. During the inspection, LPA observed a bedridden resident (R1) in shared room #2. R1 was not on hospice. Room #2 did not have an approved fire clearance for a bedridden resident. Only room #4 had an approved fire clearance for a bedridden resident. LPA observed that resident (R3) used a Foley catheter, but there was no restricted health condition exception applied for or granted for the catheter use. As a result, two (2) deficiencies were issued under regulation 87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (2) Bedridden persons and 87616 Exceptions for Health Conditions (a) As specified in Section 87209…the licensee may submit a written exception request if he/she agrees that the resident has a prohibited and/or restrictive health condition. The plan of corrections (POC) were developed with the Licensee. On 07/17/2025, the Licensee applied for a Suprapubic Catheter exception for R3 and 07/31/2025, the exception was approved by the department. Continued on LIC809-C On 07/09/2025, the Licensee submitted a request for shared room #2 to be inspected for the bedridden fire clearance. On 07/11/2025, a fire clearance inspection request was submitted to the Sunnyvale Fire Prevention Services with a request to inspect shared room #2 for the bedridden fire clearance. On 07/17/2025, a fire clearance inspection was conducted and the requested fire clearance was denied with the reason: Bedroom 2 unsuitable for bedridden residents due to lack of direct exit. The facility was also informed fire sprinkler system would be required if there are more than one (1) bedridden resident. Today (08/04/2025), the LPA inspected Bedroom #2, #4, and #7 and observed that Resident (R1) have been moved to bedroom #4 and the resident (R5) from room #4 was transferred to room #7. The previous resident (R2), who was on hospice and lived in room #7, passed away on 7/14/2025. The previous bed used by R1 was observed to be empty in the shared room #2. The deficiencies for 87202 Fire Clearance and 87616 Exceptions for Health Conditions are corrected and are cleared. No deficiencies were cited during today's visit. An exit interview was conducted with the Licensee. A copy of this report was provided to the Licensee, Fe Hilario, whose signature on this form confirms receipt of the report.