Post-licensing visit·August 22, 2025

At approximately 9:45 AM, Licensing Program Analyst (LPA) Star Stevenson arrived announced to conduct a post-licensing inspection and was greeted by administrator Omar Chiong. Facility is a Residential Care Facility for the Elderly (RCFE) licensed for six (6) residents, 6 of which can be non-ambulatory with a hospice waiver for three (3). Currently there are Three (3) residents in care. At approximately 10:15 AM, LPA initiated a tour of the facility and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperature in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed resident showers now have shower curtain rods and curtains and non-slip mats and grab bars are in place. LPA observed a supply of clean linens, hygiene products, and paper products available for residents. Hallways are equipped with night lights and residents' bedrooms have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets in communal areas of the facility containing cleaning supplies and other items that could pose a risk were observed locked. Facility has a designated locked closet, as well as locked drawer and cabinet for centrally stored medications and resident, staff, and facility files. LPA observed first aid kit, PPE, other emergency supplies, activity schedule, and games available for resident use. LPA continues to recommended that applicant add additional, age appropriate activities for elderly residents like puzzles, hangman, crafts, music, coloring, pet visits, music visits etc. Facility has a fire extinguisher, which was last inspected 10/2024 and is fully charged and licensee was advised to arrange for re-inspection and tagging soon. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Continued on LIC809-C ... ..continued from LIC809... The backyard now has level walkways and a shaded patio area and seating for resident use. A large and heavy stone counter top was observed to be leaning against a locked shed and licensee was advised to lay it flat on the ground or remove it to reduce potential risk to residents or staff in the event the stone fell over. LPA conducted a review of five (5) of 5 staff records and three (3) of 3 resident records. Four (4) of five (5) staff files were missing paperwork with S1, S2, S3, S4 had no evidence of 40 hours of training and S5 had no evidence of on-going training since administrator classes, S3 had no LIC503 (health screening), and S4 and S5 had evidence of TB clearance. In addition, S1 was not associated in Guardian and criminally cleared to work, although had evidence that two attempts to get fingerprinted resulted in poor fingerprint testing with S1 leaving during my inspection to be re-fingerprinted. Licensee was asked to ensure that S1 did not return to work until cleared to work and associated to the facility on Guardian. Three(3) of 3 resident files determined all 3 were missing Consent for Emergency Medical Treatment (LIC627c) and signed Personal Rights (LIC613) Licensee did not have current liability insurance and made a call to his insurance agent and paid for insurance during my inspection and will send in evidence of liability insurance by 08/28/2025. Continued on LIC809C Continued from LIC809C Licensee was given Guardian brochure, as well as, Technical Support Program (TSP) brochure. In addition licensee was given copy of updated RCFE educational requirements for staff members, as well as, records to be maintained at all time for both staff and residents in care and technical violations and advisories were issued. LPA obtained an updated LIC 500 Personnel Report today Licensee to send in evidence of Liability insurance by Thursday 08/28/2025 No deficiencies were cited today. Technical violations and advisories are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure follow CCR and the Health and Safety Code may result in deficiencies and civil penalty assessments during future inspections and/or case management visits. Exit interview conducted with Applicant, whose signature on this document confirms receipt.