Golden Sunset Villa Senior Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jacqueline Shaw Ross made an unannounced visit to the facility to conduct an annual licensing inspection. LPA was met by Claudia Cain, Caregiver, and was granted entry into the facility. LPA met with Mark Lu, Licensee/Administrator, and discussed the purpose of the visit. A tour of the facility was conducted inside and out. LPA, accompanied by staff, conducted a general overall inspection, which included but was not limited to the following: Facility physical plant, food service, medication management, record review and facility administration. The facility is licensed to serve six (6) elderly residents, six (6) of whom may be non-ambulatory, and one bedridden. A Hospice waiver is approved for six (6) residents. During today's inspection, LPA observed the following: Indoor and outdoor passageways were observed to be free from obstruction. There are no pools or bodies of water. Per Licensee, there are no firearms or other dangerous weapons in the facility. Poisons and cleaning agents were observed to be secured and inaccessible to residents in care. Facility fire clearance is maintained in conformity with State Fire Marshal regulations. LPA toured every room in the facility. Rooms designated as resident rooms had the required furnishings and sufficient lighting available. Licensee provided each resident with clean linen, in good repair, and sufficient hygiene products for personal use. The hot water temperature measured at 105.4 degrees F. The facility had a functioning carbon monoxide detector, multiple smoke detectors, and an operable fire extinguisher. The facility was stocked with a two-day supply of perishable food items and a seven-day supply of nonperishable food items. Staff records were reviewed and contained CPR/First Aid training, Health Screening Reports, and annual training. CONT'D ON LIC 809C... CONT'D FROM LIC 809.... Resident records were reviewed and had a current Physician's Report, Resident Appraisal, Identification and Emergency Information, Admission Agreement, and Centrally Stored Medication and Destruction Records. Medications were stored in a locked cabinet and were labeled and maintained in compliance with label instructions. Drills are conducted quarterly. The last drill was conducted on 10/2/2023. Licensee Mark Lu's administrator's certificate expires 4/22/2024. No deficiencies were observed during today's visit. This report was discussed with Licensee. A copy of this report, along with Licensee/Appeal Rights, was provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 10, 2023

Type of visit: Prelicensing

Licensing Program Analyst (LPA), Chinwe Nwogene conducted an announced pre-licensing inspection to the facility. LPA Nwogene met with Applicants, Mark Lu and Marisa Lu and toured the facility. There are currently six (6) residents in care due to a change of ownership. Application: The application is for a Residential Care Facility for the Elderly. The fire clearance has been granted for six (6) non-ambulatory residents, of which one (1) may be bedridden. Buildings and Grounds: The home is composed with living room, kitchen and dining room combination, six (6) clients bedrooms, 3 restrooms, a staff room, laundry room, backyard, and a garage. The interior/exterior walkways of the home were observed to be clutter free with no obstructions present. Smoke and Carbon Monoxide detectors were tested and operable. There are no pools or other bodies of water located at the home. According to Mark, there are no weapons stored in the home. Rooms, furniture, beds, mattresses are all in good repair. The bedrooms are furnished and privacy is available. The dining and living room areas/furniture are clutter free and in good condition. Bathrooms were observed to have non-slip mats available. The hot water was tested and measured at 119 degrees Fahrenheit which is within regulatory limits. Outdoor areas had sufficient room for activities. A washing machine and dryer are available and in working order. Central heating and air conditioning system installed with a central panel located in hallway to control entire house. Storage and Supplies: Medications will be stored in a locked cabinet in the dinning, inaccessible to any unauthorized individuals. Secured areas are available for facility files and resident files. The first aid kit was observed to be available and complete. Cleaning supplies will be stored away in the laundry room, inaccessible to clients, washing machine and dryer are all in good repair and sufficient for approved census. A Fire extinguisher was available and fully charged. CONTINUE ON LIC809-C CONTINUED FROM LIC809 Activities: Inside and outside, there are areas for residents to use for their leisure. Backyard is in good condition with a covered patio to provide shade over the outside table and chairs. Activity supplies are present inside the home, including television, magazines, and games. Food Service: Utensils and dishware are sufficient for the requested capacity. The refrigerator and stove are in working order. Sharps will be stored in a locked kitchen drawer, available only to authorized individuals. Trash can has tight-fitting lid. Dishwasher will be used to clean and sanitize dishes. All need appliances were present and shown to be in working condition and clean. The fridge was measured at 35 degrees Fahrenheit and Freezer was measures at -9 degrees Fahrenheit. Forms: The following signs were observed to be posted at the home: Emergency Disaster Plan (LIC 610E), Theft and Loss Policies, Visitors Policy, Personal Rights, rights of resident council, a Facility Sketch (LIC 999), Labor Law Information, and Complaint Information. Component III was completed during today's visit and a copy was given to Mark Lu for future reference. LPA Nwogene will inform the Centralized Applications Bureau (CAB) that the home is ready for licensure. and Applicant will be notified of the license approval. An exit interview was conducted were this report was discussed with and provided to Mark Lu.the state’s words, verbatim · CDSS document, Oct 3, 2022

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for Elderly (RCFE) Application Type: Change in Ownership (CHOW) Capacity: 6 Census (if any clients in care): 5 COMP II Participants: Mark Lu, Administrator Interview Method: Telephone interview On August 26, 2022 at 11:00 AM, Administrator participated in COMP II. Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Administrator confirmed the understanding of the California Code Title 22 Regulations. During COMP II, CAB analyst confirmed Administrator’s understanding of following areas: 1. Facility Operation: License type, client/resident populations, and program. 2. Admission Policies 3. Staffing Requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General Provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing Readiness Exit interview conducted with Administrator. Report sent via email pdf and informed Administrator to return sign form to CAB by end of business today.the state’s words, verbatim · CDSS document, Aug 26, 2022