A&C Care

Type of visit: Required - 1 Year

On 01/21/2029 at approximately 1:45PM, Licensing Program Analyst (LPA) Ali Deniz arrived unannounced to conduct 1-Year Required visit of this licensed Residential Care Facility for The Elderly (RCFE). LPA was greeted by Administrator, Chuluunchimeg Young. Facility has an approved fire clearance and capacity for 1 ambulatory, 4 non-ambulatory, and 1 bedridden resident and has an approved hospice waiver for 2 individuals. Upon arrival, LPA was informed that there were 2 residents in care and 1 staff member on-site. Facility is a 1 story building with 4 Resident bedrooms, 3 bathrooms, and common spaces. At approximately 2:05PM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 02:15PM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted. LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. LPA recommended to keep toxins separate from kitchen utensils. Toxins are stored in a locked kitchen cabinets under the sink and cabinets in the laundry room. Water temperature measured 109.6 degrees F and 107.4 which is within regulation between 105- and 120-degrees F at faucets accessible to residents. Fire extinguishers were bought new on 01/04/2025 and has not been inspected since. Gauge was on green zone (Technical advice given). Carbon Monoxide detectors were present and in order. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure. Continued on LIC809-C page... Continued from LIC809 page... At approximately 3:10PM, LPA reviewed 2 resident records and found 2 of 2 residents did have current physician's reports, care plans, signed admission agreements, and physician's orders on file. 1 out of 2 residents did not have signed personal rights (Technical Advice given). At approximately 3:25PM, LPA reviewed 2 staff records. 2 of 2 records did contain documentation of completed training records as required. Evidence of first aid and CPR training were current and/or renewed at the time of the visit. 1 out of 2 staff did not have health screening available for review (Technical Advice Given). At approximately 4:30PM, LPA reviewed the facility emergency disaster plan. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducted and documented a disaster drill on 01/20/2025. Administrator stated that they will get it done quarterly and will conduct a new drill as soon as possible and will submit copy of the proof to CCL (See LIC809D page).LPA was presented with proof of current CPR & 1st Aid certification for staff. Administrator Certificate is for Chuluunchimeg Young #7014580740 expires on 1/16/2028. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 10 days of this visit: LIC 308 Designation of Facility Responsibilities LIC 500 Personnel Summary LIC 9020 Register of Facility Resident’s Copy of Updated Certificate of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809D, Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jan 21, 2026

The state marks this report as 6 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 03/25/2025 at approximately 9:45 AM Licensing Program Analyst (LPA) Stevenson arrived and first met with Chuluunchimeg Young licensee/administrator and later her husband Alex Young who is co-licensee and an administrator to conduct an unannounced Annual Required – 1 yr. inspection of this facility. The facility has capacity for 6 clients including 5 non-ambulatory and 1 bedridden resident with a hospice clearance for 2. The facility currently provides care for 2 residents, none of which are receiving hospice services and none of which a diagnosis of dementia. At approximately 10:15 AM LPA continued with a tour of the facility with Administrator Chuluunchimeg Young and facility was found to be spacious, bright, clean, without odors and at a comfortable temperature with all exits free from obstruction. All required postings and signage at the front of the facility were found to be in order with information easily accessible for staff and residents. Residents have access to a sunroom with views of the bay, and shaded gazebo, lounging area, snacks, coffee station, large TV etc. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers found throughout the facility to be recently purchased on 1/04/2025. Smoke and carbon monoxide detectors are interconnected throughout the facility, were tested and found to be functioning. There was a sufficient supply and variety of both perishable and nonperishable and healthy foods as required by Title 22 Regulations. Licensee was advised to ensure that all food, once removed from it original/commercial bag was labeled/dated. The majority of cleaning supplies and other toxins were safely stored in a locked closet in the hallway, licensee was reminded to ensure that once cleaning supplies were used that they were quickly returned to their locked storage; today both toilet bowel cleaner and oven cleaner were found just outside locked storage closet. A lockable staff area was noted to be unlocked with potential access to over-the-counter supplements and meds used by staff and a technical violation was issued with a suggestion to use a more readily locked door like a keypad door knob or locking closet to ensure easier compliance. Continued onto LIC809-C Continued from LIC809 Sharps that could pose a danger if available to residents were found secured under the kitchen sink. There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings and bedding items. Water was measured at faucets accessible to residents and measured between 114.6 and 112.7 degrees F which is within regulation. At approximately 11:30 AM LPA conducted file review for staff and found all staff to have appropriate training, health clearance, TB testing and background clearance to work. LPA also conducted a file review for all residents. Upon review, LPA found that all resident Needs & Service Plans and Physician's Reports, TB clearance, admissions agreements and Consent from medical treatments to be current. A review and observation of the house kept MAR along with interviews revealed that one (1) of two (2) clients, client one (C1) in care did not have the day before medicines logged(picture taken) (Type B citation issued) Deficiencies are cited from the California Code of Regulations (CCRs) and/or Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations within a 12 month period, may result in a civil penalty assessment. This report was reviewed with Alex Young whose signature here indicated understanding and Appeal rights were given. LPA requested the following documents be sent to CCL by 03/25/2025:LIC 308 Designated Facility Responsibility, LIC 500 Personnel Summary, LIC 9020 Register of Facility Client’s/Resident’s, Liability Insurance (current)the state’s words, verbatim · CDSS document, Mar 25, 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 2/6/2024, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by staff, Uranchimeg Turmurbaatar. Administrator, Chuluunchimeg Young was contacted and arrived later in the visit. The facility is licensed for 5 non-ambulatory and 1 bedridden resident with a hospice capacity of 2. The facility currently provides care for 3 residents, none of which are receiving hospice services and none of which with a diagnosis of dementia. LPA continued with a tour of the facility with Administrator, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers found throughout the facility to be recently purchased on 1/9/2024 at the time of visit. Smoke and carbon monoxide detectors are interconnected throughout the facility, were tested and found to be functioning. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations, with food stored in the kitchen refrigerator found to have appropriate labeling. Staff provide residents with meals according to dietary restrictions with an ample amount of fresh and healthy foods observed. Cleaning supplies and other toxins are safely stored in a locked closet in the hallway, under kitchen sink and garage all of which were secured upon inspection. Sharps and other kitchen supplies that could pose danger if available to residents were found secured under the kitchen sink. There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings and bedding items. Water was measured at faucets accessible to residents and measured between 109.6 and 112.2 degrees F which is within regulation. Continued onto LIC809-C Medications located in designated cabinet in the kitchen area and were found to be secured. LPA conducted a spot check of medications and found all administering and records to be in order. Residents that were awake during the inspection were observed interacting with staff in the common area or in their bedroom reading for leisure. The facility also offers regular family visits and gatherings as well as encouraging residents to exercise and increase their mobility. There are two emergency exits located in the backyard which were found to be unobstructed. There is an indoor patio and large outdoor space for residents to utilize with exits equipped with ramps for accessibility. All auditory alarms leading out of the facility including resident bedroom emergency exits were also tested and all found to be in working order. The facility conducts emergency disaster drills but LPA advised Administrator to continue documentation indicating quarterly dates moving forward. Technical Advisory issued. Residents utilizing hospital bed or bed rails were found to have appropriate medical orders on file. In addition, signage for use of oxygen were posted at each door of residents requiring the use. Staff quarters were located towards the facility entrance and is kept inaccessible to residents. LPA conducted a sample file review for staff and found all staff to have appropriate annual training and 1st Aid & CPR certification on file. LPA also conducted a file review for all residents. Upon review, LPA found that all resident Needs & Service Plans and Physician's Reports to be current. All required positing and signeage at the front of the facility were found to be in order with information easily accessible for staff and residents. Administrators Chuluunchimeg Young's Administrator Certification 6046470740 and Administrator Alex Young's Administrator Certification 6046477740 are currently pending for renewal. LPA confirmed receipt of documentation and certification payments submitted to the department. LPA requested the following documents be sent to CCL by COB 2/20/2024: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Liability Insurance Control of Property/Rental Agreement No deficiencies citedthe state’s words, verbatim · CDSS document, Feb 6, 2024

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.