Routine inspection·January 27, 2024

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Xi-hua Luo . During visit, LPA observed 5 residents and 2 staff. (This report is being amended to add additional information.) LPA toured the facility inside out with ADM which included; the Living room, kitchen, dining room, 6 restrooms and 5 residents bedrooms. The staff area of the facility was also inspected. Front yard and backyard were inspected. While touring the back yard, at 8:44am, LPA observed a shed, directly across from the sun room. ADM stated this is a staff room, where her staff member sleeps. ADM knocked on the shed, and a staff member with a pink robe exited. LPA interviewed staff S1. S1 stated he/she sleeps in the shed. Based on a review of the facility sketch, this shed is not part of the facility sketch. While inspecting the shed, LPA observed two cans of paint in the backside of the shed at 8:45am. While continuing the tour of the backyard, LPA observed another shed in the backyard, directly across the previous shed, at 8:45am. LPA observed staff S2 exit the shed, staff S2 stated that was his bedroom. Two day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 71 degrees F, and hot water temperature was measured at 118 degrees F in resident bathrooms. Fire extinguisher was serviced in July 17, 2023. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on October 24, 2023. Page 1 out of 2 LPA reviewed facility records for 3 staff and 3 residents. LPA requested weight record for residents. ADM stated she used to do weigh the residents, but because they have trouble standing up, she doesn't have a weight record for those residents. The facility did not provide weight records for R1-R3. LPA reviewed 3 resident medications and centrally stored medication records. While reviewing R3's medication records, one of R3's medications was two pills short, when cross referencing the medication start date and the Medication administration record. ADM asked S3 what had occurred. S3 stated she did not know. The medication start date was January 17,2024. The MAR showed 10 medications have been administered. And an audit of the medications showed 17 tablets where in the container. ADM could not explain where the two excess pills came from. Licensee (LN) Yu Zhang stated that that backyard sheds have locks and have been locked. LN stated the residents don't have access to them. LN stated the backyard sheds are break rooms for staff to take a break as they need. LN stated no resident stays in the sheds. LPA conducted interviews with 2 staff (S1 to S2) and 2 residents (R1-R2). This report was reviewed with Administrator (ADM) Xi-hua Luo . A copy of the report was provided. Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. Appeal rights were provided.