Lucky Garden Care Home

Type of visit: Required - 1 Year

On 05/26/2026 at 1:15 PM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Care Staff, Xiaofei Fan and explained the purpose of the visit. Administrator (ADM) Isabella Joe was contacted by the phone and arrived shortly after. The Administrator holds a certificate #7002486740 and expires on 11/28/2027. LPA toured facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms which 2 bedrooms are occupied by the residents and 2 rooms is occupied by staff. There are no bodies of water observed. A comfortable temperature is maintained at 75 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 107.3 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was purchased on 04/03/2026. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 04/26/2026. At 1:26 PM, LPA reviewed 4 residents records. At 2:24 PM, LPA reviewed 2 staff records and 2 of 2 have current first aid training and associated with the facility. At 3:45 PM, LPA reviewed two samples of resident’s medications. Continue to LIC809-C... Continued from LIC809... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 06/03/2026: LIC 500 Personnel Report LIC 610E Emergency Disaster Plan LIC9020 Register of Clients/ Resident Rosters THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 1:38 PM, LPA observed unlocked eyedrops in R1 and R2's room, unlocked medication in the living room cabinets, and unlocked medication in the kitchen cabinet. At 1:46 PM, LPA observed canned goods and water in the same storage space as cleaning products and chemicals. At 1:50 PM, LPA observed a bed in the designated storage room per approved facility sketch. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with Administrator. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, May 26, 2026

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On 07/22/2025 at 2:40 PM, Licensing Program Analyst (LPA) P.Manalo arrived unannounced to deliver the amended LIC9099 Complaint Investigation report dated 07/16/2025. LPA met with staff, Na Liu and explained the purpose of the visit. Administrator arrived shortly after. Exit interview conducted and copies of this report and amended report provided.the state’s words, verbatim · CDSS document, Jul 22, 2025

Allegation investigated: Staff did not provide resident(s) with adequate food supply Staff are not providing medication as prescribed

*This is an Amended Report issued 07/16/2025* On 07/16/2025 at 8:55 AM, Licensing Program Analyst (LPA) P.Manalo arrived unannounced to deliver finding on the above allegations. During the course of investigation, LPA conducted a 10-day visit to tour the facility and interviewed Administrator (ADM), Staff 1 (S1), Resident 1 (R1) and Witness 1 (W1) on 06/06/2025. LPA obtained the Centrally Stored Medication and Destruction Record, Identification and Emergency Information, Resident’s On Lok Medication Card, Physician’s Report, Staff Medication Training, and Email Correspondence between 06/30/2025 to 07/01/2025 with Witness 2 (W2). Continue LIC9099-C... Unsubstantiated Continue from LIC9099... *This is an Amended Report issued 07/16/2025* It was alleged that; Staff are not providing medication as prescribed. Based on interviews with ADM conducted on 06/06/2025, it was found that 2 out of 3 resident’s medications are delivered on a weekly basis and will arrive at the facility on Fridays. W1 stated that the facility can either have the medication delivered monthly or weekly, and the facility requested to have the Medication Pack to arrive every Friday. W2 confirmed on 06/30/2025 that the pharmacy contracted provides residents’ medications on a weekly basis so that if there’s any changes in medications, it can be implemented within a week instead of monthly basis. Email Correspondence between W2 also confirmed the weekly basis delivery for the residents’ medications. LPA conducted a facility tour on 06/06/2026 and observed S1 unlocking the medication cabinet during the visit. LPA also observed R1’s Medication Bubble Pack dated from 06/07/2025 to 06/13/2025 at the facility. ADM stated R2’s medication will be delivered later today by the pharmacy. It was alleged that; Staff did not provide resident(s) with adequate food supply. Based on interviews with ADM it was revealed that the facility will purchase food every 3 days for the residents. Interview with R1 indicated that R1 enjoys the food at the facility. R2 and R3 were not at the facility on 06/06/2025 for an interview. LPA toured the facility and observed S1 preparing dumplings for resident’s meals. LPA inspected food supplies in the fridge and freezer that contains oranges, bananas, vegetables, meat products, and etc. During the annual visit conducted on 05/08/2025, LPA toured the facility and observed enough canned goods for each resident in care. Based on interviews and observations conducted, the above allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. There is no deficiency noted. Exit interview was conducted with Administrator, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 16, 2025 · control 15-AS-20250605155729

Type of visit: Case Management - Deficiencies

On 07/16/2025 at 9:40 AM, Licensing Program Analyst (LPA) P.Manalo arrived unannounced to deliver the complaint finding for Complaint # 15-AS-20250605155729 dated 06/05/2025. As a result, LPA conducted a case management. LPA met with Administrator, Isabella Joe, and explained the purpose of the visit. During the course of investigation, interview with Administrator revealed that the facility did not have records of the residents’ medication order for any current, discontinued, or changes to the medications. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with Administrator. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 16, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(e) · Plan of correction due date: Jul 31, 2025

(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication... This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above by not having doctor's order on file for the residents' medications which poses a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Jul 16, 2025

Plan of correction: The Administrator agrees to obtain doctor's order for all the residents' medications and send proof to CCLD by POC date.

Type of visit: Required - 1 Year

On 05/08/2025 at 8:50 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Care Staff, Na Liu and explained the purpose of the visit. Administrator (ADM) Isabella Joe was contacted by the phone and arrived shortly after. The Administrator holds a certificate #7002486740 and expires on 11/28/2025. LPA toured facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms which 3 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 71 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 105.9 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was purchased on 05/08/2025. Emergency Disaster Plan was last posted on 03/15/2025. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 04/01/2025. Continue to LIC809-C... Continue from LIC809... At 9:59 AM, LPA reviewed 3 residents records. At 10:44 AM, LPA reviewed 2 staff records and 2 of 2 have current first aid training and associated to the facility. At 11:11 AM, LPA reviewed two samples of resident’s medications. All records were observed to be complete and up to date. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 05/16/2025: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report THE FOLLOWING DEFICIENCY WAS OBSERVED DURING VISIT: At 11:30 AM, LPA observed scissors, screwdrivers, and Lysol wipes unlocked and accessible to residents. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiency by POC date may result in additional Civil Penalties. Exit interview conducted with Administrator. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, May 8, 2025

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 05/16/2024 around 11:30 AM, L. Holmes Licensing Program Analysts (LPA) L. Hall arrived unannounced to conduct a required Annual Inspection. LPA was greet by a Care Staff, and explained the purpose of the visit. Isabella Joe, Administrator (ADM), was contacted by phone and said she'd arrive in about 10 minutes; ADM arrived around 12:00 PM. The Administrator holds a certificate #600897740 that expired 11/28/23; Guardian is delayed in processing certificates. The facility’s fire clearance was approved for six (6); two (2) may be non-ambulatory residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, front yard, and back yard. The facility consists of four (4) bedrooms, a staff resting area/office, and three (3) bathrooms. All outdoor and indoor passageways are free of obstruction. A comfortable temperature was maintained at 74 degrees Fahrenheit (F). LPA observed lighting in all rooms to be adequate for the comfort and safety of all residents. The hot water temperature in the residents’ shared bathroom was measured at 107.7 degrees Fahrenheit (F). Residents’ bathrooms were equipped with grab bars and non-skid flooring. There was a 7-day supply of non-perishables and 2-days of perishable foods. Smoke detector and carbon monoxide units were in operating condition. Fire extinguisher was last serviced on 03//19/24. Emergency Disaster Plan to be updated. First aid kit was observed to be complete. Continued on LIC 809C... ...continued from LIC 809. - Post LIC 610D Emergency Disaster Plan - Review client and resident files for signatures. - Provide photos of cleared cob webs inside and outside of home - Updated facility sketch - LIC 200 - Update and post LIC 500 The following deficiency was observed. -At 3:15 PM, LPA observed there was not an updated fire clearance inspection for two ((2) of the four (4) non-ambulatory residents. The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in Civil Penalties. Exit interview conducted, Appeal Rights and a copy of this report provided to Isabella Joe (ADM).the state’s words, verbatim · CDSS document, May 16, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.