Autumn Glow

Type of visit: Required - 1 Year

On 05/16/26, LPA Yi Sam Jian conducted an unannounced annual visit to the facility. LPA met with administrator Kit Fong, LPA explained the purpose of the visit. LPA toured the physical plant. This is a 2-story building with basement level. Building has kitchen, dining room, 9 bedrooms, backyard, and 6 bathrooms. All hallways, passageways, and the backyard were observed to be free of hazards and obstructions. The kitchen was inspected, and a sufficient supply of food was observed. Infection control practices were reviewed. Medications, toxins, and sharps were stored appropriately and kept inaccessible to clients. A comfortable temperature was maintained throughout the facility, with hot water temperature inspected to be in compliant. Furnishings and lighting were adequate for comfort and safety. The carbon monoxide and smoke detection systems were inspected and meet required standards. The fire extinguisher was checked and is fully charged. Facility has a sprinkler system. The first-aid kit was inspected and is complete. Chemicals & sharps are locked. Facility has an evacuation chair in the stairwell at the second floor. No deficiencies cited today. See Advisory Note issued for technical violation. Report is reviewed and copy is provided to administrator.the state’s words, verbatim · CDSS document, Apr 16, 2026

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 05/01/25, LPA Yi Sam Jian conducted an unannounced annual visit to the facility. LPA met with the House Supervisor Yongchuan Ruan and administrator Kit Fong, LPA explained the purpose of the visit. LPA toured the physical plant. This is a 2-story building with basement level. Building has kitchen, dining room, 9 bedrooms, backyard, and 6 bathrooms. All hallways, passageways, and the backyard were observed to be free of hazards and obstructions. The kitchen was inspected, and a sufficient supply of food was observed. Infection control practices were reviewed. Medications, toxins, and sharps were stored appropriately and kept inaccessible to clients. A comfortable temperature was maintained throughout the facility, with hot water temperature inspected to be in compliant. Furnishings and lighting were adequate for comfort and safety. The carbon monoxide and smoke detection systems were inspected and meet required standards. The fire extinguisher was checked and is fully charged. Facility has a sprinkler system. The first-aid kit was inspected and is complete. Chemicals & sharps are locked. Facility has an evacuation chair in the stairwell at the second floor. No deficiencies cited today. See Advisory Note issued for technical violation. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, May 1, 2025

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 5/23/24, LPA Grace Donato conducted an unannounced annual visit to the facility. LPA met with the House Supervisor Yongchuan Ruan, LPA explained the purpose of the visit. LPA toured the facility inside and outside including a random sample of resident rooms, common areas, and kitchen area. LPA observed some residents were at the dining area eating. While touring the facility it was observed that the temperature was at 69deg F. Hot water was also tested in the resident apartments and the temperature was 110 deg F. The residents have adequate amount of linens and incontinence care items. All personal belongings are intact. Carbon monoxide monitor is working properly. All fire extinguishers have been checked and current. Facility has a sprinkler system. Resident bedrooms and bathrooms were observed to be in good repair. There is adequate amount of food, 2 days for perishables and & 7 days non-perishable. Chemicals & sharps are locked. Four resident records and four staff records were reviewed. Three out of four resident records does not have an updated LIC602 (Physicians Report). Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. Facility doesn't have an evacuation chair in the stairwell. LPA requested the following documents: LIC308, Liability Insurance, Copy of Administrator Certificate, Control of Property, LIC610. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC809-D. Failure to correct the deficiencies may result in civil penalties. Report is reviewed and a copy is provided with appeal rights.the state’s words, verbatim · CDSS document, May 23, 2024

Type of visit: Required - 1 Year

On 10/20/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived to this facility unannounced to conduct an annual visit. LPA was greeted by Assistant Administrator, Jane Mak and explained the purpose of the visit. This facility is licensed to hold up to 15 residents who are 60 and older. 15 out 15 residents may be non-ambulatory. This facility also holds a dementia plan on file and has a hospice waiver for 2. Shortly after, LPA met with Facility Designated Administrator (FDA), Kit Fong. Current census was 15. A brief interview with (AM) Mak was conducted. LPA reviewed 6 resident files and 5 staff files. The Facility Designated Administrator, Kit Fong, has a current and active administrator certificate #6063650740 and expires on 08/05/2024. 6 out 6 residents files were missing the LIC 613-safeguard for personal valuables and personal rights. 2 out 6 resident files did not have an updated Physicians report. 4 out 5 staff files were current and up to date. 1 out 5 staff files did not have a current first aid certificate. A tour of the facility was conducted. This facility has 3 floors and a roof top terrace. The facility elevator was last serviced on 02/02/2023 and is valid until 02/02/2024. The facility was last serviced by AU Electric Coporation to ensure that smoke alarms, carbon monoxide detectors and the Fire System was in working condition. A tour of the basement floor was conducted. Office area was toured. A tour of the laundry room was conducted. Toxins and cleaning supplies were observed to be inaccessible to the residents in care. A medication cart was observed next to the laundry room. Along with the FDA and AM, LPA compared medication to medication dispensing logs. First Aid kit was present and had all the required components. Tour of the kitchen was toured. LPA observed a sufficient amount of 2 day perishable and 7 day nonperishable food supply for the residents in care. A tour of the resident lounge was conducted. Furniture and furnishings were observed to be in good repair at this time. A tour of the 1st floor and 2nd floor was conducted. Each floor holds a fire extinguisher that was services by AAA restuarant on 08/02/2023 and was observed to be in compliance at this time. Each floor also has 4 resident bedrooms. Furniture and furnishings were observed to meet the residents needs at this time. This facility holds 2 resident bathrooms on each floor. Hot water temperature was observed was taken to ensure that it dispensed water between 105 to 120 degrees. A tour of the facility roof was conducted. A tour of the perimeter was conducted with no hazards present. Perimeter fence and gates were observed to be in good repair. The following documents were requested to updated and sent to CCL: -LIC 308 -LIC 309 -LIC 400 -LIC 500 -LIC 610 Technical assistance is being provided today for the following sections: 87506(b) and 87465(h)(5) Per California Code of Regulations (CCR) – Title 22 – Division 6, Chapter 6, deficiencies were observed during today’s visit. Citations can be found on the LIC 809 – D. Failure to correct deficiencies may result in civil penalties. Appeal Rights were provided to the facility. An exit interview was held, and a copy of the report was provided in-person.the state’s words, verbatim · CDSS document, Oct 20, 2023