Routine inspection·June 7, 2024

On 6/07/2024 at 2:45 p,m. Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced Required annual inspection and was met by Designated Administrator (DADM) Rita Garcia. The Administrator(ADM) Yiwen (NIcole) Shih was not present at the time of the visit. DADM called ADM and asked if LIC/ADM can come to the facility. LIC/ADM stated he/she is not available due to prior commitment. The facility is a Residential Care Facility for the Elderly (RCFE) licensed to serve ages 60 and over, capacity for 6 ambulatory of which 6 may be non-ambulatory and 6 hospice waiver. The facility has 3 residents that are neurocognitive impaired. 1 out of 2 staff were present at the time of the visit. 3 residents were present at the facility. 2 out of 3 are under the age of 60, 1 out 3 is non-ambulatory, 2 out of 3 are ambulatory, 3 out 3 have neurocognitive impairment. LPA and DADM toured the facility inside and outside, including but not limited to the following: Kitchen, dining, laundry, garage, 4 resident room, 1 staff room, 2 bathrooms, backyard and the exterior walkways. LPA observed the Personal Rights disclosure, Long Term Care Ombudsman (LTCO) and Centralized Complaint and Information Bureau (CCIB) of the CA Department of Social Services (CDSS) prominently posted on the wall, visible to visitors, resident and staff. The temperature inside the home was at 69 to 71.1 degrees F. LPA observed the kitchen to be organized, and sanitary with working appliances. Knives were kept in a secure locked area and not easily accessible to residents. The laundry area is located in the garage, cleaning supplies and laundry detergents are kept in a secure locked place not easily accessible to residents in care. The facility has 2 days of perishable food and 7 days of non-perishable food. page 1 of 2 LPA inspected the residents' bedrooms and found that 4 out of 4 rooms have furniture and closet space for resident's personal belongings, bed frames with mattress and bed linens. 4 Out of 4 resident room is sanitary, organized and are free from debris. LPA observed that the 1 Out of 2 bathrooms have rust on the floor of the shower and tub combination, stains on the toilet bowls, sink, faucet, trash bins and the floor. LPA with ADM tested the water temperature for kitchen and bathrooms, water temperature was measured at 105.6 degrees F to 113 degree F. LPA with DADM inspected the laundry area and observed washer and dryer are in good working condition. LPA observed that the medication is in a locked cabinet. The facility has a first aid cabinet with first aid supplies and accessible to staff. The side door and sliding door to access the backyard opens easily and are free from obstruction. LPA observed ramps and walkways are free from obstruction. LPA observed the backyard area to be free from debris and is maintained. The facility is in a compound with two other facility under the same ownership. LPA reviewed facility record and 2 out of 2 staff record, and 3 out of 3 resident records. The disaster training has not been conducted since the facility got licensed on 6/16/2023. 2 out of 2 does not have a CPR training, 2 out of 2 staff does not have on boarding training, 1 out 2 recently started with employment. Residents files were reviewed to be complete. Residents' medications are labeled and current. LPA discussed with DADM the importance of fire and earthquake training and the required training for the staff that was recently hired. page 2 of 3 During document review and observation, LPA observed that 2 out of 3 of the resident (R1 and R2) were under the age of 60 and facility did not submit an exception request and notify licensing to admit and retain residents under the age of 60. LPA requested documents from DADM such as, LIC 500, lease agreement, updated liability insurance and LIC 308 to update the facility record. LPA discussed with DADM the Summer Wellness Preparedness Readiness that is available online for the DADM and LIC/ADM to discuss and train staff. Deficiencies are cited during today's visit based on the California Code of Regulations (CCR) Title 22, see LIC 809D. An exit interview was conducted with designated administrator (DADM) Rita A Garcia. A copy of the report and appeals rights were provided.