Facility Evaluation Report, 10/10/2023 — Kun Bai Care #2 Home, Lake Elsinore CA

Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with Volunteer/Non-Client Resident Jair Melgarejo Martinez was granted entry to the facility. Administrator Brandon Marquez-Gutierrez arrived at the facility after LPA made a phone call to the licensee. At the time of the visit there was one (1) staff present, one (1) Volunteer/Non-Client Resident present, and three (3) residents present.

The facility is a four (4) bedroom, two (2) bathroom home with a kitchen/dining area, living room, and attached garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory residents and the current census is three (3) residents. LPA was accompanied by Administrator to conduct a general overall inspection, which included, but was not limited to, the following:

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. The resident’s (R1, R2, & R3) bedrooms did not have sheets and mattress covers on their beds. The shower in R2 and R3’s bedroom did not have a non-slip mat on the shower floor. Deficiencies will be issued for the sheets, mattress covers, and non-slip mat. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathroom to be at 109.7 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, labor laws, and the disaster plan were posted in a common area.