A Beloved Home of Diamond Bar

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual visit using the Compliance and Regulatory Enforcement (CARE) Tool. LPA was greeted by Rio Basco and explained the reason for the visit. Administrator Elizah Arganosa arrived shortly thereafter. This home is licensed to serve residents ages 60 and over, six (6) non-ambulatory of which 1 may be bedridden. Bedridden bedroom is room 3. Facility is approved for six (6) hospice residents. There was one (1) residents under hospice care during inspection. Facility Tour & Observations Personal Rights postings (LIC 613C and Ombudsman), Complaint Poster (PUB 475), and nondiscrimination notice were observed in a common area. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present. Physical Plant The facility is located in a residential area and is a one-story home consisting of five (5) resident bedrooms, two (2) restrooms, one (1) main bathroom, one (1) shared bathroom (in bedroom),living room, kitchen, dining area, laundry room, attached garage, front yard, and backyard. LPA observed five (5) resident bedrooms, and all contained the required furniture (bed, mattress, linens, dresser, chair, and lighting). Cleaning supplies and toxic substances are inaccessible to residents in a locked kitchen cabinet under sink. Bathrooms were clean and equipped with required grab bars in showers and near toilets, as well as non-skid mats; hot water measured in bathroom (1) 109.8°F and bathroom (2) 112.5°F which is within the required 105–120°F. Extra linens and towels were available in a hallway cabinet. Smoke/carbon monoxide detectors were functional, fire extinguisher were located by the front entrance and garage. There were no bodies of water present. Backyard provided shaded seating. Passageways and exits were observed to be clear and unobstructed. Food Service Refrigerators/freezers were maintained at proper temperatures (refrigerators maximum of 40 degrees °F and freezer 0-degree °C) with sufficient supply of 2-day perishable and 7 days non-perishable food. Fresh produce, proteins, and dry goods were stocked. Knives and were observed in a locked kitchen drawer. (Continued on LIC809C) Health-Related Services & Records Five (5) residents files were reviewed and contained current required documents Admissions Agreements, Pre-Placement Appraisals, Consents, Needs/Service Plans, Physician’s Reports with TB/ambulatory status and Rights acknowledgments. Five (5) residents’ medications were reviewed; medications were observed to be centrally stored in a locked kitchen cabinet. MAR logs were observed to be current. Disaster Preparedness Last fire/earthquake drill was conducted on October 27, 2025, with logs available. LIC 610D Emergency Disaster Plan was posted in kitchen bulletin board. Emergency supplies (water, food, flashlights, batteries, first aid) were observed in the garage. Infection Control Plan was updated. Personnel Records & Training Four (4) staff files were reviewed and included criminal record clearances, CPR/First Aid, required training and TB screenings. Administrator Certificate for Eliza Arganosa was valid through October 22, 2026. Insurance Liability insurance was in compliance with an expiration date February 25, 2026. An exit interview was conducted with the Administrator Eliza Arganosa. During the inspection, the facility was observed to be following Title 22, Division 6 regulations. No deficiencies were cited at this time. A copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 14, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Cynthia Chan and Luis DeLeon conducted the unannounced annual inspection on 10/29/24. LPAs met with Staff, Genia Polistico, and explained the purpose of the visit. The assistant administrator, Elizah Arganosa, arrived shortly after to assist with the visit. The facility is licensed to serve 6 non-ambulatory residents, ages 60 and over. One may be bedridden and is approved for bedroom #3. There is a hospice waiver approved for 6. The facility is a single story home with 5 resident bedrooms, 1 staff room, 2 bathrooms, open living room, dining room, and kitchen, laundry room, and attached garage. Garage has an additional storage room. There is no swimming pool on the premises. The bathrooms have non-skid mats in the shower area and grab bars. Facility has smoke and carbon monoxide combo detectors that are operable and interconnected. Knives, cleaning solutions, and disinfectants are locked, making them inaccessible to residents. The facility has auditory devices on the exit doors. There is a sufficient food supply of 2 day perishable and at least a week of non-perishable food maintained at the facility. The hot water temperature was measured at 110.6 degree F which is within the required range. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is maintained. Staff and Residents files are stored and maintained at the facility. LPAs reviewed 5 resident and 4 staff files to ensure all required forms are in their files. One of the resident files did not have the TB test results upon admission. Medications are centrally stored and locked. LPA reviewed medications and there are no discrepancies. The facility accepts and retains residents with dementia and/or hospice. The facility has a "no smoking oxygen in use" sign posted at the facility and in front of the resident's room. Emergency Disaster Plan is easily accessible and disaster drills are conducted monthly. A deficiency is issued on the LIC809D. An exit interview was held and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Oct 29, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Wong conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to caregiver Rio Basco and administrator MyMy Dong arrived shortly after and assisted with the visit. The facility is licensed for age range 60 and over. Non-ambulatory of which 1 may be bedridden. Hospice Waiver for 6. The following 12 (CARE) tool domains were utilized during the inspection: Infection Control, Operational Requirements, Physical Plant/Environment Safety, Staffing, Personnel Records/Staff Training, Resident Records/Incident Reports, Planned Activities, Food Service, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. 1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. Covid-19 Screening for visitor still in place. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. 2. Operational Requirement: A current Plan of Operation at the facility is completed. Hospice waiver plan and dementia plan was reviewed. The Infection Control Plan has been added to the Plan. A fire clearance is for 6 non-ambulatory of which one (1) maybe bedridden. Currently, there's only one bedridden resident in the facility. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place. 3. Physical Plant and Environmental Safety: The facility is a single story house and located in a residential neighborhood area. The facility includes: living room, kitchen, four residents bedrooms, two resident's bathroom, staff break room, live in staff room, laundry room and attached garage. Bedroom#1 and #4 has two beds, two chairs, required furniture and beddings and sufficient lighting and closet space. Bedroom#2 and #3 has one bed, one chair, one night stand, drawers, required furniture and beddings and sufficient lighting and closet space. All two residents bathrooms have the required grab bar and non-skid mat. The bathrooms are clean, sanitary and in a good working condition. The hot water in both bathrooms were tested between 112.1 and 113.1 which is within the Title 22 regulation. (See LIC 809C for continuation) All knives and sharp utensils are stored in a locked box in kitchen drawer. All the cleaning solutions and chemicals are stored and locked in the overhead cabinet in the laundry room. The extra linen and personal hygiene products are stored and in the hallway cabinet. LPA inspected the carbon monoxide detectors are working properly. The passageway, patio and walkway are free of obstruction. 4. Staffing: The facility has sufficient number of staffing. The facility has at least one staff with CPR training. The night shift staff also received the facility emergency planned training and has an updated First Aid Training in place. 5. Personnel Record and Training: All the facility staff are over 18 years old, associated and fingerprint cleared with the facility. The administrator is My My Duong and her administrator certificate expiration date on 7/18/2024. All the staff has the required documents in their personnel files which includes: health screening, TB Test result, required training hours and updated first aid certificate. 6. Resident Record/Incident Reports: LPA inspected all three (3) resident files and they all have the required documents which include : face sheet, update physician report, TB test result, needs and service plan, admission agreement, medication record and pre-appraisal assessment. A death report/incident report blinder was reviewed. 7. Resident's Right: LPA observed the Long Term Care Ombudsman poster, CCL complaint poster and personal right in the living room. The facility would provide internet service with at least one internet access device for resident to have video conferencing with their family members if needed. 8. Planned Activities: The facility has a sufficient space to accommodate both indoor and outdoor activities was observed. 9. Food Service: Currently no resident is required modified diet prescribed by the physician. The facility has sufficient 2 days perishable and 7 days non-perishable food supply in the facility. All the food are stored properly. 10. Incidental Medical and Dental: LPA inspected three (3) resident medication. The medication is centrally stored and locked in the hallway cabinet. All resident's medication are seemed accurate and updated. All the residents have the 30 days supply of medication. Facility staff also provide transportation to resident medical and dental appointment if needed. 11. Disaster Preparedness: The facility has an updated Emergency Disaster Plan (LIC610D) in place and its updated on 4/2/23. The last fire/earthquake/flood drill was conducted on 8/1/23, 9/1/23 and 10/1/23. The facility has two temporary alternative shelter location. Records of resident Appraisal and Needs services plans are part of Emergency training. 12. Residents with Special Health Needs: No residents in the facility with prohibited health condition. Currently there's one resident on hospice and one on home health. Individual Service Plan and appraisals are on resident's files for home health and hospice. Half and full bed rails for mobility assistance were observed in resident rooms. No deficiencies were observed during the visit. Exit Interview Conducted. A copy of the report was provided to the administrator MyMy Duong.the state’s words, verbatim · CDSS document, Oct 13, 2023