Beck Care Home

Type of visit: Case Management - Health Checks

Licensing Program Analysts (LPAs) David Marrufo and Marcela Yanez conducted an unannounced Case Management visit and met with Administrator (ADM) Xi-Hua "Julia" Luo. The purpose of the visit was to conduct a health and wellness check on the facility residents. During visit, LPAs toured the facility with ADM. LPAs observed six out of six residents during visit. LPAs observed one resident with a catheter. ADM stated that she had not inserted or removed the resident's catheter. ADM stated staff only assist with emptying the catheter bag. ADM stated the resident's hospice nurse handles all the rest of the duties related to the catheter. During visit, LPAs toured the inside and outside of the facility. During visit, LPAs discussed with ADM about the importance of cooperating with the department and attending any required meetings, including Non-compliance conference meetings. ADM stated she is willing to cooperate with the department. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Xi-Hua "Julia" Luo and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 1, 2026

Allegation investigated: Neglect/Lack of Supervision: Facilty staff changed resident's catheter causing serious injury wherein resident had dark blood and discomfort

On February 25, 2026 Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced complaint investigation visit to deliver findings and met with Xi-Hua Luo, Administrator (ADM). LPA announced the purpose of the visit. On July 16, 2025 the department received a complaint with the allegation for Neglect/Lack of Supervision: Facility staff changed resident's catheter causing serious injury wherein resident had dark blood and discomfort. On July 18/2025 Licensing Program Analyst (LPA) Marcela Yanez conducted a 10-day complaint investigation visit and obtained pertinent documents. page 1 of 2 Unfounded During the investigation the department interviewed 2 staff (S1-S2) and Administrator (ADM) On 07/07/25 Resident (R1) was receiving hospice services and had had an issue with his/her catheter. R1 was found by staff S1 nat 5:00pm with urine and blood on his/her bedding. Staff (S1) stated he/she called ADM to inform what was going on. ADM arrived shortly after and observed R1 in pain and grimacing and the resident had no urine output for about 8 hours. ADM, who is a Licensed Registered Nurse , stated that the caregiver had called the Hospice nurse and informed them what was going on and that the hospice nurse was on their way to the facility. ADM stated it had been almost an hour since the hospice nurse had been notified and that the resident had a distended abdomen and pain in which the ADM took it upon him/herself to remove the catheter placement and reinsert the suprapubic catheter. Witness (W1) arrived after ADM had changed the catheter and decided to call the ambulance. R1 was sent to the hospital where R1 was admitted with a chief complaint of blood in the urine. Based on R1s medical records during the hospital visit a Computed Tomography, (CT) scan was done and the results of (CT) indicated catheter was in good position and clinically draining well with no need for bladder irrigation. R1 condition was stable and returned to the facility the same day. On July 12. 2025 R1 passed away, based on record review R1s cause of death was not related his/her catheter care. The department has investigated the complaint allegations listed. Based on interviews and review of records, the department has found that the complaint allegation is unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. No deficiencies cited during today's visit per California Code of Regulations, Title 22. An exit interview was conducted with the Licensee and a signed copy of this report was provided During the investigation the department interviewed 2 staff (S1-S2) and Administrator. On 07/07/25 Resident (R1) was receiving hospice services and had had an issue with his/her catheter. R1 was found by staff S1 nat 5:00pm with urine and blood on his/her bedding. Staff (S1) stated he/she called ADM to inform what was going on. ADM arrived shortly after and observed R1 in pain and grimacing and the resident had no urine output for about 8 hours. ADM, who is a Licensed Registered Nurse , stated that the caregiver had called the Hospice nurse and informed them what was going on and that the hospice nurse was on their way to the facility. ADM stated it had been almost an hour since the hospice nurse had been notified and that the resident had a distended abdomen and was in pain in which the ADM took it upon him/herself to remove the catheter placement and reinsert the suprapubic catheter. ADM stated that staff had called hospice nurse and informed him/her of resident’s condition. ADM stated that anytime a resident is on hospice services the staff inform the hospice nurse before calling 911. ADM stated that when a resident moves into the facility the POA is notified regarding any resident health update or financial concern. ADM stated that POA stated to please contact Care Manager regarding any health concerns due to Care Manager being located closer to the facility. At the time of incident staff notified Care Manager of residents condition and was instructed to call Hospice Nurse. Based on interviews and record review the incident that occurred on July 7 2025, the facility followed hospice procedure and called hospice nurse of R1's catheter leaking blood and urine. ADM stated that the staff called Care Manager who arrived shortly after the catheter was reinserted. Based on interviews, records review and observations, the department has determined that although the allegations 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. No deficiencies cited during today's visit per California Code of Regulations, Title 22. An exit interview was conducted with the Licensee and a signed copy of this report was provided On 07/07/25 Resident (R1) was receiving hospice services and had had an issue with his/her catheter. R1 was found by staff S1 at 5:00pm with urine and blood on his/her bedding. Staff (S1) stated he/she called ADM to inform what was going on. ADM arrived shortly after and observed R1 in pain and grimacing and the resident had no urine output for about 8 hours. ADM, who is a Licensed Registered Nurse , stated that the caregiver had called the Hospice nurse and informed them what was going on and that the hospice nurse was on their way to the facility. ADM stated it had been almost an hour since the hospice nurse had been notified and that the resident had a distended abdomen and pain in which the ADM took it upon him/herself to remove the catheter placement and reinsert the suprapubic catheter. W2 stated that the resident moved into the facility on March 1, 2025 and had a catheter that was being cared for by home health. ADM provided a copy of R1s Hospice agreement dated April 7, 2025 stating that Hospice services would oversee changing the catheter once a month. ADM stated she was aware of the agreement. ADM felt that the resident was in pain and discomfort and felt it was necessary to change the catheter because of no urine output. ADM did not have a doctor’s written order stating he/she was authorized to change R1s catheter. R1 was under a Hospice service agreement that states Hospice services will be provided by a hospice nurse. Hospice nurse was notified by staff at the facility and did not arrive till shortly after R1s catheter was already changed by the ADM. R1s was sent to the hospital to check if the catheter was properly placed and there was no injury from the ADM changing the catheter. Documentation stated R1s catheter was properly placed and clinically draining well. Although ADM is a Licensed Registered Nurse he/she did not follow the signed Hospice Agreement dated February 25, 2026. Based on interviews and documents review the preponderance of evidence standard has been met therefore the above allegations is found to be SUBSTANTIATED. Citations noted today. Please see LIC9099-D. Exit interview was conducted with Xi-Ha Luo, ADM. A copy of the report and appeals rights were provided.the state’s words, verbatim · CDSS document, Feb 25, 2026 · control 26-AS-20250716141943

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87623(a)(1)(B) · Plan of correction due date: Feb 26, 2026

87623 In Dwelling Catheter (B) A catheter shall only be inserted and removed by an appropriately skilled professional under physician's orders. This requirement is not met as evidenced by: Based on record review and interview, ADM changed the Resident R1s catheter without a doctors order and did not follow hospice care plan dated 04/07/25 in which hospice services would change catheter every month which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 25, 2026

Plan of correction: ADM stated will submit a written plan of action understanding the regulation and will follow hospice care plan for residents requiring services from hospice nurse by POC due date. Administrator agreed and understood.

Allegation investigated: Facility staff using resident's room as hallway to get to the backyard.

On 12/4/2025 Licensing Program Analysts (LPAs) Marcella Tarin and David Marrufo arrived unannounced to deliver an amended complaint finding from unsubstantiated to substantiated. On 1/15/2025 the Department received a complaint alleging facility staff using resident's room as hallway to get to the backyard On 8/4/2025, LPA Tarin interviewed Reporting Party(RP). RP stated he/she has told staff S2 not to walk through R1’s room. RP stated he/she was visiting R1 in his/her bedroom, when S2 entered R1’s bedroom to access the backyard of the facility. RP stated the door was closed and S2 did not knock. RP did not provide additional information regarding this incident. Page 1 of 2 Substantiated On 1/24/2025, the Department interviewed staff S1. S1 stated they sometimes use the resident's room to go to the backyard because it has an exit door. S1 stated staff knows they should go around through the siding door of the living room or garage. On 7/17/2025, LPA Tarin interviewed ADM. ADM states she has not observed staff using a residents room as a hallway to get to the backyard. On 9/25/2025 LPAs interviewed S2 to S3. Staff S2 stated he/she has never used or observed a staff used a resident’s room to exit to the backyard. Staff S3 stated he/she has never seen staff use a resident’s room to exit to the backyard. On 9/25/2025, LPAs interviewed 3 Residents R2 to R4. 3 Out of 3 (R2-R4) residents did not provide answers to questions LPAs posed regarding this allegation. On 10/9/2025, LPA interviewed Resident R4. R4 state he/she has no issues. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED, perCalifornia Code of Regulations, Title 22 a deficiency is being cited on the attached LIC 9099D. Appeals right were provided. Page 2 of 2 END OF REPORTthe state’s words, verbatim · CDSS document, Dec 4, 2025 · control 26-AS-20250115102820

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(C) · Plan of correction due date: Dec 11, 2025

87307 Personal Accommodations and Services (C) No bedroom of a resident shall be used as a passageway to another room, bath or toilet. This was not met as evidenced by: Based on interviews, S1 stated they sometimes use the resident's room to go to the backyard because it has an exit door. Continue to next section.the state’s words, verbatim · CDSS document, Dec 4, 2025

Plan of correction: Licensee states she will submit a plan of correction on how she will provide additional staff training on resident's personal rights to include residents privacy and not using a resident's room as a passageway. Licensee will submit POC to CCL by POC due date 12/11/2025. Continuation from previous section...S1 stated staff knows they should go around through the siding door of the living room or garage, which poses a potential health, safety and personal rights risk to residents.

Type of visit: Case Management - Incident

Licensing Program Analysts (LPAs) Marcella Tarin and David Marrufo arrived unannounced and conducted a Case Management to amend a prior complaint. LPAs met with Administrator (ADM) Xi-Hua 'Julia' Luo. Upon walking up to the front door, LPAs observed a clear bin, with a yellow lid located on the left side of the front door step. Upon further inspection LPAs observed the words "MED BOX" written on the top yellow lid of the bin. LPAs advised ADM to not use an unlocked, and unsupervised medication box and to collaborate with hospice to ensure medications are locked and not accessible to residents in care. LPAs reviewed Title 22 Regulation, 87465 Incidental Medical and Dental Care with ADM to ensure resident's medications are being centrally stored and not accessible to residents in care. During visit, ADM removed the med box from the front door step. A Technical Advisory was issued, see LIC9102. An exit interview was conducted an ADM Xi-Hua 'Julia' Luo, and a signed copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 4, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPAs) Marcella Tarin and Steve Chang, and Licensing Program Manager (LPM) Romeo Manzano arrived unannounced to conduct a Case Management-Other visit. The purpose of this visit it to follow up on a deficiency issued on 10/17/2025 and the status of the facility. LPAs and LPM met with Administrator (ADM) Xihua ‘Julia’ Luo. LPAs and LPM stated the purpose of the visits. During today's visit, LPAs toured the kitchen area with Staff S1 and Staff S2. LPAs observed frozen fish in a metal bowl on the kitchen counter, knives in the dish rack, and a medication cup with 5 pills on a tray. S1 stated the frozen fish was thawing for 20 minutes, and the medication cup had be pre-filled by Staff S2. LPAs and LPM stated to S1 and S2 to place the frozen fish in the refrigerator to thaw, to lock the knives away and to lock up the medication cup. ADM stated she will provide additional training on food safety and storage of medication. A Technical Violation was issued for food safety and medication storage. LPAs observed the facility to have sufficient food and sufficient staffing for residents in care. LPAs and LPM observed cameras in the kitchen and living room area. LPM and LPAs stated to ADM to submit a program regarding the video cameras being used in the facility. A Technical Assistance was issued. LPAs interviewed ADM Xihua 'Julia' Luo states she is considering closing the facility, due to ADM's husband/Licensee. ADM states this has been a frustrating situation with the Licensee. ADM states Licensee is 'difficult' to work with. ADM states if she cannot work with Licensee, she will not have a choice but to move to the next step of closing the facility. Page 1 of 2. LPAs and LPM stated to ADM the obligations and duties as the ADM and Licensee of the facility to collaborate and inform CCLD regarding any changes at the facility LPAs and LPM discussed with ADM the facility closure procedure and provided ADM with a printed copy of Health and Safety Code 1569.682. The facility was cited the following deficiencies on October 17, 2025 with the following POC dates and is being cleared today: Deficiency §1569.50 Denial, suspension or revocation of license, Type A, POC due 10/18/2025. A Letter of Deficiency Citations cleared was provided to ADM. No deficiencies were cited during today's visit per California Code of Regulations. Two Technical Violations and a Technical Assistance were issued, see LIC9102 for more information. An exit interview was conducted with ADM, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 29, 2025

Type of visit: POC

Licensing Program Analysts (LPAs) Mita Partoza and Marcella Tarin conducted a POC case management visit to clear deficiencies cited on October 2, 2025 and October 9, 2025, during a case management / Complaint investigation visit. LPAs met with Administrator (ADM) Xi-Hua (Julia) Luo and stated the purpose of the visit. Clearing pending Plan of Corrections: The facility was cited the following deficiencies on October 2, 2025 with the following POC dates and is being cleared today: • 87468.1 Personal Rights of Residents in All Facilities (a) Type A- POC due date October 3, 2025. Plan of Correction received on October 9, 2025. • 87202 Fire Clearance (a) -Type A, Issued CP of $800.00 beginning October 9, 2025, and will continue to accrue until corrected. • 87755 Inspection Authority of the Licensing Agency (a) - Type A, Issued initial CP of $800.00 beginning October 9, 2025 and will continue to accrue until corrected. The facility was cited the following deficiencies on October 9, 2025, with the following POC date and is being cleared today: • 87625 Managed incontinence (b)(2), Type A – POC due date October 10, 2025. Plan of Correction received on October 9, 2025. Page 1 of 2 •87507 Admission Agreements (g)(3)(B)(2), Type B- POC due date, October 16, 2025. Plan of Correction received on October 9, 2025. • 87405 Administrator Qualifications (d)(2), Type A – POC due date, October 10, 2025. Plan of Correction received on October 9, 2025 A Letter of Deficiency Citations Cleared was provided to ADM for the above deficiencies. LPAs Tarin and Partoza inspected the backyard shed and observed the shed being used as a storage area. On 9/25/2025 LPA Manuel Monter and Marcella Tarin conducted the facility's annual inspection. During the exit interview with Licensee, Licensee verbally threatened to take LPAs state owned phones and break them. Licensee stated LPAs did not have the authority to inspect and take pictures of the facility backyard shed. Based on review of the Department's approved facility's sketch dated 10/15/2007, the backyard shed is part of the facility sketch. A deficiency is being issued to the Licensee. A deficiency is being cited during today's visit per California Code of Regulations, Title 22. This report was reviewed with ADM Xi-Hua (Julia) Luo and a copy of the signed report and appeal rights were provided. Page 2 of 2 END OF REPORTthe state’s words, verbatim · CDSS document, Oct 17, 2025

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.50(3) · Plan of correction due date: Oct 18, 2025

§1569.50 Denial, suspension or revocation of license;...(3) Conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California This was not met as evidenced by: On 9/25/2025 the Licensee verbally threatened to take LPAs state owned phones and break the phones, which is a conduct inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of Californiathe state’s words, verbatim · CDSS document, Oct 17, 2025

Plan of correction: ADM stated that he/she will submit a written Plan of Correction (POC) to address the issue of conduct inimical with the Licensee. The POC will be submitted to CCL by POC due date 10/18/2025. (con't) which pose/poses an immediate health,safety and personal rights risk to persons in care.

Allegation investigated: Resident was overcharged for extra month of rent. Resident's bedrail and wheels on hospital bed are not in good repair. Facility staff are not trained to assist residents with transfers. Resident's private caregiver sleeping on the couch in the living room

Licensing Program Analyst (LPA) Marcella Tarin and Manuel Monter conducted an unannounced visit to deliver the complaint findings and met with administrator Licensee Julia Luo. LPA stated the purpose of the visit. On 1/15/2025 the Department received a complaint alleging a resident was overcharged for extra month of rent. It has been alleged that R1 was overcharged for an extra month of rent for the month of January 2025. On 1/15/2025 the Department interviewed Reporting Party (RP). RP stated he/she decided to take R1 out of the facility on 1/13/2025. RP stated he/she did not provide a 30 days’ notice for the facility. On 7/17/2025, and 9/25/2025 LPA Tarin interviewed ADM. ADM stated RP did not provide a 30 days’ notice when RP moved R1 out of the facility on 1/12/2025. Page 1 of 4 Unfounded The Department requested documentation regarding R1 contracting norovirus, but RP did not provide the Department with said documentation. On 1/24/2025 LPAs Christine Dolores and Santino Fortes conducted the initial complaint investigation visit. During the initial visit, LPAs observed PPE supplies to include gowns in the linen closet, gloves in a separate closet which contained toxins, and hand sanitizer at the front door. On 1/24/2025 and 7/15/2025 the Department interviewed staff S1. S1 stated staff cares for residents with COVID-19 by using PPE supplies such as gloves and gowns. S1 states the facility notifies families of any illnesses or outbreaks. S1 stated the facility provides PPE, and staff care gloves. On 7/15/2025 Licensing Program Analyst Marcella Tarin interviewed ADM. ADM states in the event of an outbreak the facility staff will follow the facility infection control policy. ADM stated staff wash hands multiple times daily and in between caring for residents. ADM states staff clean and disinfect the facility at least 2 times a day and are using sanitizing wipes daily as well. ADM stated there are currently no illness/COVID cases at the facility, but if there were, the staff would be using Personal Protection Equipment (PPE). ADM stated PPE equipment is available to staff, such as gloves, masks, face shields. ADM states staff always use gloves when caring for residents, and if a resident has a cold, masks are worn by both residents and staff. On 9/25/2025 LPA Tarin interviewed Staff S2 and S3. S2 stated he/she is not aware of any outbreaks of COVID or Noro virus. S2 states the facility follow infection protocol by wearing gloves, masks and sanitizing, and letting the ADM know is residents are sick. S3 stated he/she facility follows infection control protocol, and staff wear gloves, masks, and clean/disinfect. On 10/6/2025, LPA Tarin interviewed Witnesses (W1 to W5). 4 out of 5 Witnesses stated he/she has observed staff wearing gloves. W1 did not provide information regarding staff wearing gloves. 5 Out of 5 witnesses stated he/she observed the facility to be clean and sanitary when they have visited his/her loved one at the facility. Page 2 of 3 On 9/25/2025, LPAs interviewed 3 Residents R2 to R4. 3 Out of 3 (R2-R4) residents did not provide answers to questions LPAs posed regarding this allegation. On 10/9/2025, LPA interviewed Resident R4. R4 state he/she has no issues. Facility staff using resident's room as hallway to get to the backyard. On 1/15/2025 the Department received a complaint alleging Facility staff using resident's room as hallway to get to the backyard On 8/4/ 2025, LPA Tarin interviewed Reporting Party(RP). RP stated he/she has told staff S2 not to walk through R1’s room. RP stated he/she was visiting R1 in his/her bedroom, when S2 entered R1’s bedroom to access the backyard of the facility. RP stated the door was closed and S2 did not knock. RP did not provide additional information regarding this incident. On 1/24/2025, the Department interviewed staff S1. S1 stated they sometimes they use the resident's room to go to the backyard because it has an exit door. S1 stated staff knows they should go around through the siding door of the living room or garage. On 7/17/2025, LPA Tarin interviewed ADM. ADM states she has not observed staff using a residents room as a hallway to get to the backyard. On 9/25/2025 LPAs interviewed S2 to S3. Staff S2 stated he/she has never used or observed a staff used a resident’s room to exit to the backyard. Staff S3 stated he/she has never seen staff use a resident’s room to exit to the backyard. On 9/25/2025, LPAs interviewed 3 Residents R2 to R4. 3 Out of 3 (R2-R4) residents did not provide answers to questions LPAs posed regarding this allegation. On 10/9/2025, LPA interviewed Resident R4. R4 state he/she has no issues. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was provided. Page 3 of 3 END OF REPORT Review of documentation provided by RP, RP did not provide a 30 days notice to the facility regarding R1 moving out. Documentation states RP requested to pick up R1's belongings from the facility on 1/13/2025." Based on review of R1’s Invoice dated for January 2025, dated 1/17/2025, the invoice states “Discharge notice on 1/12/2025 ahead 30 day requirement based on the admission agreement, start on 1/13/2025 until last room on board date 2/12/2025 at $210.00 per day.” Review of R1’s Admission Agreement dated 4/19/2024 under Refund Policy, states “Residents moving out due to non-medical reasons requires 30 days advance notice…resident or the residents responsible person give a thirty-day (30 days) written notice to the licensee.” RP moved out R1 on 1/12/2025 without providing a 30 days notice to the facility. Resident's bedrail and wheels on hospital bed are not in good repair. On 1/15/2025 the Department received a complaint alleging Resident's bedrail and wheels on his/her hospital bed are not in good repair. On January 15, 2025 and August 4, 2025, the Department interviewed Witness RP. RP stated the facility provided R1 with a hospital bed that was not in good repair. RP states the hospital bed was not stabilized but did not provide details about the hospital bed. On January 24, 2025, the Department interviewed Staff S1. S1 stated R1’s hospital bed and half rails were not in disrepair. S1 showed LPA Dolores and Santino how they use the rails and LPAs observed it was in working condition. On 9/25/2025, LPA Tarin interviewed 2 staff, S2 to S3. Both staff interviewed stated they have not observed a bed in the facility that was not in good repair On 9/25/2025, LPAs interviewed 3 Residents R1 to R3. 3 Out of 3 residents did not provide answers to questions LPA’s posed. Page 2 of 4 On 10/9/2025, LPAs interviewed 2 residents (R5 and R6). 2 Out of 2 residents stated he/she has no issues with his/her bed. On 10/2/2025, LPA’s toured the facility and inspected all residents beds. LPA’s observed 6 out of 6 resident beds to be in good repair with no issues. On 10/2/2025, LPA’s interviewed ADM. ADM stated R1's bed was not in disrepair. ADM stated the wheels on R1's bed would sometimes slide on on the hardwood floor when R1 was transferring out of the bed to a chair. On 10/6/2025 LPA Tarin interviewed 5 Witnesses (W1 to W5). 4 out of 5 witnesses stated he/she has not observed a resident's bed in disrepair. W1 did not provide additional information. Facility staff are not trained to assist residents with transfers. On 1/15/2025 the Department received a complaint alleging Facility staff are not trained to assist residents with transfers. On 1/24/2025, LPA Dolores interviewed Staff S1. S1 stated staff receives training quarterly. S1 stated staff received training on how to transfer residents. On 1/17/2025, LPA Tarin interviewed ADM. ADM stated all staff have been trained to transfer residents. ADM stated the training was conducted by a third-party home health agency. On September 25, 2025, LPA interviewed Staff S2 and S3. Both staff interviewed stated he/she has been trained in how to transfer residents. On 9/25/2025, LPAs interviewed 3 Residents R1 to R3. 3 Out of 3 residents did not provide answers to questions LPA’s posed. Page 3 of 4 This page was inadvertently amended. On 9/30/2025 the Department interviewed ADM. ADM stated the facility does not provide care and services for residents from 10:00PM to 6:00AM. ADM states the ‘night charges’ are not listed in the admission agreement. ADM states ‘night charges’ are explained to resident’s responsible parties before being admitted into the facility. Review of R1’s ‘Night Charges’ log, R1 was charged for ‘night services’ on the following dates: 7/25/2024, 8/5/2024, 9/7/2024, 9/10/2024, 10/3/2024, 10/5/2024, 10/07/2024, 11/6/2024, 11/08/2024, 11/12/2024, 12/31/2024, 1/4/2025. R1’s ‘night services’ are listed as “diaper change, ” “toileting.” Review of R1’s Admission Agreement dated 4/19/2024, under 5.1 Basic Services, a. “Assistance with bathing, dress, grooming, toileting, eating, continence, transferring from bed or chair, and other personal needs.” Under 5.1 Basic Services, j. “continuous supervision and observations for changes in physical, mental, emotional, and social functions.” Based on review of R1's physician report dated 12/16/2024, R1's has bladder and bowel impairments and requires assistance with toileting needs. Review of R1's care plan dated 4/20/2024 states staff will assist R1 with bladder and bowel incontinence. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22 is being cited on the attached LIC 9099D. On 10/9/2025 LPAs interviewed 2 residents (R5 and R6). 2 Out of 2 residents stated he/she has no issues when staff assist him/her with transferring. Based on review of Staff Training and In-Service Record dated 12/27/2024, staff received training on ‘transfer skill training with PT/OT. LPA also reviewed the documentation Caregiver Training for R1 dated 1/8/2025 provided by a third-party home health agency. Documentation included staff signatures and topics such as transferring R1 from wheelchair to bed, bed to wheelchair. Based on document review, the facility provided training every quarter from 1/26/2024 to 1/8/2025, which included transferring residents from wheelchair to bed, postural support, and assisting during transfers. Resident's private caregiver sleeping on the couch in the living room On 1/15/2025 the Department received a complaint alleging Resident's private caregiver sleeping on the couch in the living room. On 7/16/2025, LPA interviewed ADM. ADM stated he/she has not observed a resident’s private caregiver sleeping on the facility couch. On 7/16/2025 and 9/25/2025, LPAs interviewed 3 Staff. 3 Out of 3 staff stated they have not observed a resident’s private caregiver sleeping on the facility couch. On 9/25/2025, LPAs interviewed 3 residents (R2 to R4). 3 Out of 3 residents did not respond to questions posed by LPAs. On 10/9/2025, LPAs interviewed 2 residents (R5 and R6). R5 and R6 stated they have not seen staff or private care givers sleeping in the couch. R5 and R6 stated they have not seen this. This agency has investigated the complaint alleging a resident was overcharged for extra month of rent, resident's bedrail and wheels on hospital bed are not in good repair, facility staff are not trained to assist residents with transfers, resident's private caregiver sleeping on the couch in the living room. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.the state’s words, verbatim · CDSS document, Oct 9, 2025 · control 26-AS-20250115102820

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87625(b)(2 · Plan of correction due date: Oct 10, 2025

87625 Managed incontinence (b)(2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. This is not met as evidenced by: Based on interview and document review, ADM stated she doesn't check the residents at night 10pm-6am. This poses an immediate health, safety, and personal rights risks to residents in care.the state’s words, verbatim · CDSS document, Oct 9, 2025

Plan of correction: ADM stated she will develop an incontinence plan for all her residence who are incontinent. ADM stated this plan will ensure that all incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. ADM stated she will also send a letter of understanding regarding the regulation. ADM stated she will submit the plan of correction by POC due date, October 10, 2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(3)(B)(2) · Plan of correction due date: Oct 16, 2025

87507 Admission Agreements (g)(3)(B)(2) A separate charge for an item or service may be assessed only if that charge is included in and authorized by the admission agreement. This requirement was not met as evidenced by; Based on interview and records reviewed, the facility charged resident for care being provided from 10pm-6am. ADM stated the night charges are not reflected on the admission agreement. This poses an immediate health, safety, and personal rights risks to residents in care.the state’s words, verbatim · CDSS document, Oct 9, 2025

Plan of correction: ADM stated she will send a letter of understanding regarding the regulation. ADM stated she will submit the plan of correction by POC due date, October 16, 2025

Type of visit: POC

On October 9, 2025, LPA Manuel Monter and Marcella Tarin conducted a POC visit. LPAs met with Administrator / Licensee Xi-Hua Luo (ADM1). LPAs explained the purpose of the visit. On October 2, 2025, the facility was issued the following Type A Deficiencies with a POC date of October 3, 2025. As of today’s visit, the licensee has not submitted or corrected citations resulting in civil penalties. The following deficiencies were cited during a complaint investigation visit/ case management deficiencies visit conducted on October 2, 2025, and are as follows: • 87468.1 Personal Rights of Residents in All Facilities (a) - Type A, issued initial Civil Penalty (CP) of $500.00 beginning October 4, 2025, and will continue to accrue until corrected. • 87202 Fire Clearance (a) -Type A, Issued initial CP of $500.00 beginning October 4, 2025, and will continue to accrue until corrected. • 87755 Inspection Authority of the Licensing Agency (a) - Type A, Issued initial CP of $500.00 beginning October 4, 2025 and will continue to accrue until corrected. Civil Penalties issued today for the maximum of $1500, for failure to correct. LPAs informed ADM that if the 3 deficiencies are not corrected, civil penalty will continue to accrue until corrected. LPA discussed about the importance of Plan of Correction. ADM agreed and understood. Page 1 Out of 2. The Facility was cited an additional deficiency during todays visit, under code section, 87405 Administrator Qualifications and Duties (d)(2). During today's inspection deficiencies were issued. See LIC809D. This report was reviewed with Administrator / Licensee Xi-Hua Luo (ADM1). A copy of this report was provided during exit interview. Appeal rights were provided. Page 2 Out of 2.the state’s words, verbatim · CDSS document, Oct 9, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(d)(2) · Plan of correction due date: Oct 10, 2025

87405 Administrator Qualifications and Duties (d)(2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement was not met as evidence by: Based on the results of today's visit, the administrator did not submit the plans of correction by POC date. This poses an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 9, 2025

Plan of correction: ADM stated she will submit a letter of understanding regarding the regulation. ADM stated her letter will state her understanding regarding her duties and responsibilities as administrator, and the importance of completing plans of correction by POC date. ADM stated she will submit the plan of correction by POC date, October 10, 2025.

Allegation investigated: Facility staff using storage shed in the backyard as habitual space. Facility staff not safeguarding resident's personal items.

Licensing Program Analysts (LPAs) Marcella Tarin and Manuel Monter conducted an unannounced visit to deliver the complaint findings and met with Administrator (ADM) Julia Luo. LPA stated the purpose of the visit. On January 15, 2025 the Department received a complaint alleging facility staff using storage shed in the backyard as habitual space. On January 15, 2025, the Department interviewed W1. W1 stated there is a staff, S2, who lives in the storage shed in the back. W1 stated he/she has seen S2's personal belongings in the shed. On January 24, 2025, LPA Dolores interviewed Staff S1. S1 denied the allegation that the shed being used as a living space for staff. S1 stated the shed is being used for storage to store extra beds. Page 1 of 3 Substantiated LPA Kabariti interviewed ADM. ADM stated she could not open the shed. ADM called her husband/licensee and placed her husband on speaker phone. The Licensee refused to open the shed. LPAs observed the shed was locked. The windows were black therefore LPAs could not see what was inside the shed. The shed had a power line that was running from the facility to the shed. ADM denied staff living in the shed. ADM states the shed is used for gardening supplies and only the gardener and owner has a key to the shed. On July 17, 2025 LPA Tarin interviewed ADM. ADM 1 stated staff did not live in the shed. On 9/25/2025, LPAs inspected the back yard. LPA Monter and LPA Marcella observed Staff S2 seated on a chair next to the storage shed in the back yard. LPA Monter asked S2 what’s inside the storage shed. S2 stated it’s a staff’s bedroom. LPA Monter asked S2 who’s bedroom does the shed belong to. S2 then clarified that he/she doesn’t know. LPA Tarin asked if LPAs could look inside the shed. S2 then stated the shed is locked and he/she doesn’t have the keys. LPA Tarin told S2, that the shed door is slightly ajar. S2 then went to check and acknowledged the shed was open. LPA Monter and Tarin observed the inside of the shed, which contained the following, but not limited to items: a mini fridge, bed (with blankets & pillows), an ignited lamp night stand, dresser with phone charger on top of it, grooming products, and other personal items. (LPA took photographs of the inside contents of the shed.) S2 then clarified that the storage shed was a sleeping area for other employees, not just him/her. LPA’s interviewed staff S2 and S3. S2 states no staff live in the backyard shed. S2 states he/she only uses the shed when he/she's on break. S2 states it's a 'staff room." S3 states no staff live in the backyard shed. On October 2, 2025, LPA Tarin and Monter interviewed ADM. ADM stated no staff sleep in the shed or use the shed as a staff room. ADM stated the shed is a storage space. Based on review of the facility sketch and the facility fire clearance dated 10/6/2008, the backyard shed is part of the facility and is not listed as a staff bedroom or sleeping area. Based on interviews and documents review the preponderance of evidence standard has been met therefore the above allegations is found to be SUBSTANTIATED. Page 2 of 3 Facility staff not safeguarding resident's personal items. On 1/15/2025 the Department received a complaint alleging Facility staff not safeguarding resident's personal items. On January 15, 2025, the Department interviewed Witness W1. W1 stated S2 has stolen (R1) shoes. W1 stated when he/she had asked about R1's shoes, staff S2 brought them out from his/her room (storage shed). On January 24,2025, LPA Dolores interviewed Staff S1. S1 denied staff using resident's personal items. Staff denied observing other staff use a resident's personal items. On January 24 and July 17, 2025, the department interviewed ADM. ADM stated a caregiver used residents shoes because his/her shoes got wet when bathing a resident. S2 borrowed shoes to obtain dry shoes from his/her car. ADM immediately corrected S2 and apologized to R1. ADM stated she has never had issues with resident's personal belongings until the incident with staff S2 using R1’s shoes. On 9/25/2025 the Department interviewed staff S2 to S3. S2 states he/she has never worn a resident's personal belonging such as clothes or shoes. S2 stated he/she has never worn another residents shoes or personal belongings. S3 stated he/she is not aware of any staff using/wearing a residents shoes or personal belongings. Based on review of an Employee Individual Consultation document dated 6/18/2025, S2 was given a written warning by ADM, the document is signed by S2. Based on interviews and documents review the preponderance of evidence standard has been met therefore the above allegations is found to be SUBSTANTIATED. Licensee stated if the complaint report involved the backyard shed, he would not sign the report. Page 3 of 3 On September 25, 2025, LPA Tarin interviewed Staff S2 and S3. Both staff interviewed were asked questions regarding this complaint investigation. Both staff were able to understand the questions that were posed by LPA’s and were able to provide responses to all questions posed. LPAs interviewed Resident R1 to R3. 3 Out of 3 Residents were did not provide responses to questions posed during interview. On October 2, 2025, LPA interviewed staff S1-S3, ADM 1 and ADM 2. S1 to S3, ADM 1 and ADM 2 were able to respond to LPAs questions regarding emergency procedures, evacuation routes, and general care questions. This agency has investigated the complaint alleging facility staff are not able to communicate to resident and cannot speak English. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.the state’s words, verbatim · CDSS document, Oct 2, 2025 · control 26-AS-20250115102820

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Oct 3, 2025

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This is not met as evidenced by: Based on interviews and documentation reviewed, the licensee did not comply with the section cited above. ADM stated a staff used a residents shoes, and S2 was given a written warning by ADM. This poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 2, 2025

Plan of correction: ADM will submit a statement of understanding regarding the regulation cited. ADM will conduct an in-service training for staff regarding resident's personal rights. ADM will submit documentation of in-service training to CCL by POC due date 10/3/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Oct 3, 2025

(a) All facilities shall maintain a fire clearance approved by the city,... fire department... and obtain an appropriate fire clearance approved by the city, county, or city and county fire department ... This is not met as evidenced by: Based on investigation, LPAs observed a shed in the backyard being used as a staff sleeping area. Fire Clearance/Facility Sketch does not note the shed as a staff room/sleeping area. This poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 2, 2025

Plan of correction: ADM will send photo documentation showing the storage area is no longer being used as a sleeping area. ADM stated she will also send a letter of understanding stating no staff or any individual is allowed to sleep in the following areas without building permit and fire clearance such as but not limited to; the sheds, living room, and garage.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst Manuel Monter and Marcella Tarin conducted a POC case management visit to clear deficiencies cited on September 25, 2025, during an annual inspection visit. LPA also citing the facility an additional deficiency that erroneously not cited during the previous visit. Clearing pending Plan of Corrections: The facility was cited the following deficiencies on September 25, 2025 with the following POC dates: 87307 Personal Accommodations and Services (d)(6)- Type A- POC due date September 26, 2025. 87468.2 Additional personal rights of residents in Privately Operated Facilities (a) (4) Type A- POC due date September 26, 2025. 87468.1 Personal Rights of Residents in All Facilities (a)(1)- Type A- POC due date September 26, 2025 87468.1 Personal Rights of Residents in All Facilities (a)(2) – Type A- POC due date September 26, 2025 87463 Reappraisals (a) – Type B- POC due date of October 2, 2025. During todays visit, LPA's toured the facility side entrance and observed the locked gate no longer had a lock. LPA's requested ADM to review the camera's video footage. ADM provided LPA's access to the cameras and confirmed they are not recording audio. LPA received plan of corrections by POC date. Deficiencies cleared during todays visit. Page 1 Out of 2. Follow Up, regarding 9/25/2025 annual inspection visit. During the annual inspection visit, the department inadvertently did not cite an issue that was noted during the end of the annual inspection. On September 25, 2025, LPA’s Manuel Monter and Marcella Tarin, during the conclusion as of the annual inspection, ADM2 asked if LPA's took photos during todays visit. LPA confirmed due to the current ongoing complaint investigation, LPA's did take photographs of the inside of the shed. ADM2 stated they LPA's cannot do this. ADM2 stated the lease agreement states the shed is not part of the facility. ADM2 stated LPA’s do not have the authority or right to inspect the shed in the backyard or take pictures of the inside of the shed. ADM2 stated if he was there when LPA's took the photos, he would have taken the phones and broken them. LPA told ADM2, the shed is not going to be discussed anymore and that the report needed to be reviewed. ADM2 stated he wanted to see the LPA's delete the photos or he wouldn't review the report or sign the report. LPA Monter told ADM2, the photos will not be deleted. ADM2 stated he refused to sign. ADM1 then attempted to interject, but ADM2 stated, no, and insisted that the photos needed to be deleted. During todays visit, LPA’s discussed Title 22 regulation, 87755 Inspection Authority of Licensing Agency (a). LPA’s also discussed that the administrator of the facility must collaborate with licensing. LPA’s informed ADM that, due to an open complaint about the backyard shed, the Department will fully investigate the allegation. The LPAs also brought up ADM2’s comment that was made on September 25, 2025 — that he would have broken the LPAs’ state phones if the shed photos were not deleted — noting that it could be construed as a threat or an intimidation attempt. A deficiency is being cited during todays visit. This report was reviewed with Licensees Yu Zhang & Xi-Hua Luo. A copy of this report and Appeal rights were provided. Administrator refused to sign. ADM2 stated if the report had anyting to do with the shed, he would refuse to sign.the state’s words, verbatim · CDSS document, Oct 2, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87755(a) · Plan of correction due date: Oct 3, 2025

87755 Inspection Authority of the Licensing Agency (a) Any duly authorized officer, employee ...of the licensing agency may …and inspect the entire premise ...without advance notice. This requirement was not met as evidence by: Based on interviews, ADM2 stated the LPA’s do not have the authority to inspect the shed, & stated he would have taken the phones and broken them, if he was present when the photos were taken. This poses an immediate health, safety, personal rights risks to residents in care.the state’s words, verbatim · CDSS document, Oct 2, 2025

Plan of correction: Licensees/ ADMs stated they will send a letter of understanding regarding the regulation. Licensees/ADM’s stated they will submit a written plan to ensure licensing agency/staff have access to enter and conduct inspection of all areas of the facility, including the shed. Licensees/ ADMs stated they will submit the written Plan of Correction by POC due date October 3, 2025.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit and met with Administrator Xi-Hua Luo. During the visit, LPA observed 6 residents and 3 staff. LPA explained the purpose of the visit was to conduct the annual inspection, continue the complaint investigation for the complaint 26-AS-20250115102820 and follow up on an incident report regarding an elopement. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 5 restrooms and 6 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. While touring the side of the facility, adjacent to the kitchen/ family room, LPA observed the side gate had a lock, obstructing the side exit. (Photograph of the lock gate was taken.) ADM stated the gate is locked because resident R1 has wandering behaviors. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 79 degrees F, and hot water temperature was measured at 106.7 degrees F to 113 degrees F in resident bathrooms. Fire extinguisher was serviced in July 2025. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on 8/26/2025.. LPA reviewed 3 resident medications and centrally stored medication records. LPA reviewed facility records for 3 staff and 3 residents. Based on a review, resident R1's needs and services plan has not been updated, and does not address R1's wandering behavior. Page 1 Out of 3. While touring the home, LPA's observed resident R2 seated in a wheel chair in front of the dinning room. LPA's then noted resident's wheel chair was tied to the dinning table. (Photograph was taken.) LPA's asked staff S1 why R2 was tied. S1 stated R2 will sit on his/her wheel chair alongside the dinning room table and push him/herself. S1 stated she doesn't know since when R2 was being tied. S1 stated R2 isn't being tied everyday. Staff S2 stated the ADM, S1, S3 and him/herself has been tying R2 to the table since the past 2 weeks. S2 stated they tied R2 because he/she pushes him/herself against the dinning room table, which almost causes R2 to fall. Staff S3 stated the care givers on shift, including him/herself has been tying R2 when he/she is sitting at the dinning room table. S3 stated the tying has been occurring for over a month. ADM stated R2 has been pushing him/herself against the table the past week. ADM stated he/she doesn't know since when R2 has been tied. LPA asked ADM if she has ever tied R2, ADM stated During the tour of the facility, LPA's noted facility cameras throughout the facility. LPAs asked ADM if the cameras record with audio. ADM stated confirmed the cameras inside the facility do record with audio. LPA asked ADM how often she checks the video cameras. ADM stated she checks everyday. Incident Report, dated September 19, 2025 On September 19, 2025, the Department received an incident Report regarding resident R1. The incident Report stated, on September 16, 2025, at 3:00pm, R1 had episode of wandering out of the facility. Staff checked on R1 around 2:30pm and R1 was asleep in bed. Around 3:00pm, staff went to R1’s room and couldn’t find him/her. Staff checked all inside and outside of facility, but R1 wasn’t found. The facility has camera around all exit doors and R1 wandered out from side yard gate. All exit door have alarms. The alarm was working when R1 exited, but staff did not check the alarm. Staff had searched all neighborhood, still could not find R1. Staff received call from EMT stating they received a call from people walking in the street regarding R1. R1 sent to hospital. On September 19, 2025 LPA Partoza interviewed staff S1. S1 stated R1 has a wandering behavior and they have an alarm on all the doors. S1 stated that at 2:30 p.m. R1’s Family member (FM) came and asked for R1. FM stated that R1 was not in the room, S1, proceeded to go look for R1 inside the facility. S1 stated when he/she went outside at the backyard, he/she saw the backyard gate open. Page 2 Out of 3. On September 19, 2025, LPA Partoza interviewed Administrator Julia Zhang. ADM stated that R1 has a wandering behavior and likes to walk around the house and the backyard. ADM stated they keep a latch on the backyard gate, but at 2:00 p.m. another resident was dropped off by a driver from a transportation provider. The resident came from his/her dialysis appointment and went through the side gate. The side gate was left open by the driver and did not close the gate. ADM stated that's what she was told by the staff. ADM stated that a neighbor saw R1 and called the ambulance. ADM stated he/she received a call from the EMT. ADM stated that EMT called the care facilities in the neighborhood and used the CCLD website and contacted the facilities around the neighborhood. ADM stated usually R1 doesn’t leave the facility, this was the first time this happened after being at the facility for 10 months. R1 was brought to Good Samaritan Hospital and was released back to the facility. On September 25, 2025, LPA Monter interviewed ADM. ADM stated she was informed about R1's elopement around 3:29pm. ADM stated she was near the facility and when she arrived, she searched for R1. ADM stated at 3:45pm, she received a call from EMT stating they found R1 by his/herself. As a result, An immediate civil penalty of $500.00 is being assessed against the facility today for violation the absence of supervision, which resulted in R1 eloping from the facility. Deficiencies cited during today's visit. Administrator refused to sign. ADM stated he wanted LPA to delete photos of inside of shed. LPA stated, the ongoing complaint investigation regarding the shed is still under investigation. LPA informed ADM the photos taken of the shed will not be deleted. Page 3 Out of 3. END OF REPORTthe state’s words, verbatim · CDSS document, Sep 25, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Xi-Hua Luo. During the visit, LPA observed 6 residents and 2 staff. LPA explained the purpose of the visit. LPA toured the facility inside out which included the Living room, kitchen, dining room, 5 restrooms and 6 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. LPA's toured the facility garage, which is being used as a storage area / Laundry area. While touring the backyard of the facility LPA's observed a shed. LPA's requested to enter the shed. ADM stated she doesn't have the key and her husband has the key. ADM stated the shed is being used as storage. LPA's looked thru the window and observed that a light was on inside the shed. ADM stated the staff and the residents don't use the storage shed. ADM stated her husband, the owner of the home and co-licensee has the key, because the residents and staff don't use the shed. ADM stated yesterday the gardener was at the home, and stated that is why the light may have been left on. LPA's informed ADM the Department would do a follow up visit to inspect the shed in the backyard. While touring the kitchen of the facility LPA's asked Staff S1 to show where the facility has their knives. S1 pulled opened a drawer in the kitchen, adjacent to the kitchen stove. Inside the drawer was two knives (3:41pm). (Photographs were taken.) ADM stored the knives in a locked cabinet during LPA's visit. LPA observed the medication cabinet had a lock that wasn't engaged, LPA asked Staff S1 to lock it. LPA observed the cabinet below the sink, lock was also not engaged. LPA asked S1 to lock it as well. Page 1 Out of 2. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 74 degrees F, and hot water temperature was measured at 115 degrees F in both resident bathrooms. Fire extinguisher was serviced in July 11, 2024. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on July 2, 2024. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 1 staff and 2 residents. A deficiency cited during today's visit. This report was reviewed with Administrator Xi-Hua Luo and a copy of the signed report was provided. Appeals rights were also provided Page 2 Out of 2. END OF REPORT.the state’s words, verbatim · CDSS document, Oct 29, 2024