Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Dieu-Qui H Nguyen . During visit, LPA observed 4 residents and 3 staff.

LPA toured the facility inside out with ADM which included; the Living room, kitchen, dining room, 3 restrooms and 4 residents bedrooms. The staff area of the facility was also inspected. Front yard and backyard were inspected. There was no obstruction to block the walkways.

Two day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication closet, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F, and hot water temperature was measured at 117 degrees F in both 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 July 28, 2023.

LPA reviewed facility records for 3 staff and 3 residents, ADM stated she did not have staff records available for LPA to review, ADM stated its on her hard drive and would get them once her computer is fixed. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 4 staff (S1 to S4) and 2 residents (R1-R2). While interviewing Staff S2, S2 stated he/she sleeps in bedroom #3. ADM confirmed that staff S2 was sleeping in bedroom #3. ADM stated she would move that staff member to the staff area instead.

Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. Exit interview was conducted with Administrator Dieu Qui H Nguyen and a copy of the signed report & appeal rights were provided.