The facility is licensed to operate for six (6) nonambulatory residents of which one may be bedridden and have a hospice waiver for four (4) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, two (2) staff room, two (2) bathrooms, living area, dining area, kitchen, outdoor covered patio, and an attached two car garage.

LPA Kim toured inside and outside of the physical plant with LI Pao. There were no bodies of water. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 109.9 degrees F to 110.3 degrees F. A comfortable temperature of 75 degrees F was maintained in the facility.

LPA Kim observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, emergency water, and emergency supplies are stored in the garage. The facility has two (2) fire extinguishers that are charged and mounted in the kitchen and the garage, and both extinguishers were last inspected on July 11, 2024.

Evaluation Report Continues on LIC 809-C

LPA Kim conducted an audit of resident files (R1-R6), staff files (S1-S7), and medication administration record. LPA Kim conducted four (4) resident interviews and three (3) staff interviews.

Deficiencies were cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. A technical violation was issued at the time of the visit.

An exit interview was conducted, and a copy of this report and appeal rights were provided to Licensee Adriel Pao.