Facility Evaluation Report

On 9/5/24 at 2:00pm Licensing Program Analyst (LPA) Kevin Gould and department representative Shariff Osman conducted an unannounced Case Management inspection to address deficiencies observed in facility operation. LPA met with Licensee, Ratu Vunimatana and informed him of the concerns of the department and discussed a potential meeting with the department to discuss the changes of facility operation.

LPA Gould observed the facility, in contradiction to their own plan of operation, are now accepting residents with a diagnosed mental health disorders. Per their approved plan of operation, the facility would only accept residents with a diagnosis of dementia and those with a mental health diagnosis beyond dementia, would not be admitted to the facility. Several of the residents admitted to the facility have a history of self harm and may pose a danger to themselves or others and there is no identified precautions documented in the plan of operation to ensure residents safety.

LPA also observed the facility is currently not in compliance with the facility fire clearance as approved by the local fire department and community care licensing. Per the approved fire clearance, the facility is approved for 6 non-ambulatory residents and one bedridden resident in room #5. As part of LPAs observations, bedroom 5 has been converted to a staff bedroom and the facility no longer has a capacity for bedridden clients in its current configuration.

The following deficiencies are cited per California Code of Regulations, TITLE 22.

Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the home.