Cyecrest Guest Home

Allegation investigated: Facility did not have sufficient staffing to meet the needs of the resident(s) in care. Facility did not maintain required liability insurance. Facility funds are not sufficient to meet operating needs. Facility failed to obtain a physician report prior to being admitted. Facillity did not adequately assess resident prior to admission. Staff were not adequately trained. Staff did not document resident's change in condition. Faclility failed to provide a request for records from Attorney Facility violated fire clearance by retaining a bedridden individual Facility did not report incident(s) which threatened the welfare, safety or health of any resident in care.

On this day, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the allegations listed above. LPA was greeted and granted entry by facility staff after introducing himself and stating the purpose of the visit. Administrator Tin Le was notified of the visit and presented with the allegations under review. The initial complaint investigation visit was conducted by LPA Michelle Reed on July 19, 2022. During the visit, licensing staff met with facility staff. There were two residents present, both of whom were in hospice. Health and safety checks were conducted on the premises and resident records for resident R1 were requested. Additional investigation was conducted by the Department. R1 was admitted to the facility on December 3, 2021, from a different residential care facility for the elderly with hospice care already in place with Vitas Hospice. CONTINUED ON LIC9099-C Substantiated On January 13, 2022, the hospice provider was changed to Bridge Hospice, which had been the R1 provider prior to her relocation at the facility. Resident appraisal established on the same day indicates: "Bedbound, incontinent, paralysis of left arm, dementia" with an indication that resident is "In bed part of the time". Resident assessed as non-ambulatory. There is a physician report on file, with a primary diagnosis of Senile degeneration of the brain as well as a confirmed indication of dementia. The resident was, however, not assessed to be bedridden per the physician who established the report. The physician report is not dated nor signed, so its accuracy cannot be fully verified. Per the death certificate provided, R1 passed away on January 20, 2022. Regarding the allegation that, Facility did not have sufficient staffing to meet the needs of the resident(s) in care, the following has been concluded: Based on the LIC500 Personnel Report form dated July 20, 2022. The facility only has two caregivers on staff with no provisions for weekends, nights and potential absences and sick days. At the time, there were two residents admitted to the facility per the Register of Facility Residents (LIC9020), both of which are non-ambulatory and receive hospice care, therefore the lack of planned contingencies is a risk for the health and safety of both residents in care. Bridge hospice visits notes dated January 14, 2022, indicate: “[Skilled Nurse] provide a detailed education to staff on keeping the wound clean. Staff at [board and care] are overwhelmed. SN attempted to educate related to the patient’s condition. Staff told SN we are not medical professionals. Staff in the home appear overwhelmed and anxious. SN reported to nursing supervisor and to the patient’s [R1] son.” Regarding the allegation that, Facility did not maintain required liability insurance, the following has been concluded: The Department requested proof of required liability insurance to the license and reviewed the documentation provided. The coverage reviewed was found to not meet the requirements of Health and Safety Code Section 1569.605 stating coverage should “have a least one million dollars per occurrence and three million dollars in the total annual aggregate”. The licensee’s policy provided such coverage for two separate LLC entities and up to three facilities over some periods. It was also found that coverage had lapsed for the period from January 17, 2022, until February 14, 2022, indicating that the licensee did not have liability coverage for that period. Regarding the allegation that, Facility funds are not sufficient to meet operating needs, the following has been concluded: After reviewing the available documentation, the Department determined that the licensee does not have an adequate financial plan to ensure residents’ care and supervision won’t be interrupted. CONTINUED ON LIC9099-C Bank statements from the facility were requested, provided and reviewed during the audit. Ending balances were observed to be gradually diminishing from August 2021 until the account reached a zero balance in July 2022. Administrator Chi Luu stated that the account had been closed due to a change of ownership towards a different entity, however at the time of the present visit, the facility is still licensed to Luxury Living LLC. Regarding the allegation that, Facility failed to obtain a physician report prior to being admitted, the following has been concluded: The physician report for R1 is neither dated nor signed and therefore does not meet the requirements established in Title 22 regulations applicable to resident records. There is additionally no indication of R1’s tuberculosis status. Given the absence of a valid physician report in R1’s records, the allegation is Substantiated. Regarding the allegation that, Facility did not adequately assess resident prior to admission, the following has been concluded: The physician report on file does not indicate whether R1 has any indications of tuberculosis or other transmittable diseases prior to admission. The assessment conducted prior to admission within the facility does therefore not meet Title 22 requirements. The allegation is found to be Substantiated. Regarding the allegation that, Staff were not adequately trained, the following has been concluded: email staff records provided to LPA Reed in July 2022 by facility administrator failed to evidence that both staff members scheduled at the facility during R1’s admission had received any and/or sufficient initial and recurring annual training beyond some training evidenced to have been received in 2019 prior to either staff members being hired in October 2021 by the facility. Regarding the allegation that, Staff did not document resident's change in condition, the following has been concluded: Following an initial request and multiple follow-ups for licensing staff, facility staff provided the Department with resident records for R1. No charting notes are present. While recurring hospice visits are adequately documented from admission on December 3, 2021, until the resident’s passing on January 15, 2022, there appears to be no documentation of facility staff interventions. Upon the resident’s change of condition when R1 appears to start actively transitioning per hospice staff, no reassessment of the resident’s condition or ambulatory status were documented or presented as evidenced during the investigation. Regarding the allegation that, Facility failed to provide a request for records from Attorney, the following has been concluded: The law office representing the responsible party for resident R1 made a formal request for records from the facility staff on April 18, 2022 and had not received applicable documentation at the time of the present complaint being filed in July 2022. CONTINUED ON LIC9099-C Per Title 22 regulations, facility records should have been provided within two business days. The allegation is therefore Substantiated. Regarding the allegation that, Facility violated fire clearance by retaining a bedridden individual, the following has been concluded: Based on the documentation on file provided by facility staff, the resident appraisal for R1 is not fully consistent and states that R1 is bed-bound and spends most of the time in bed. The physician report provided does not indicate on the other hand that the resident was either bedridden or unable to reposition in bed independently. One care staff interviewed during the initial investigation visit stated R1 could not reposition themselves independently. Other staff interviewed were not questioned on the matter. Hospice plan of care review conducted by Vitas Hospice staff on December 9, 2021, lists the residents as bedbound. The Hospice assessment established by Bridge Hospice on January 13, 2022, also indicates the resident is bedbound. Additionally, the content of the physician report cannot be fully corroborated due to the absence of indication of the identity of the physician responsible for the assessment along with the fact that the document is neither signed nor dated. As a result, the allegation is Substantiated. Regarding the allegation that, Facility did not report incident(s) which threatened the welfare, safety or health of any resident in care, the following has been concluded: Per a review of hospice records provided by Vitas Hospice, hospice staff was called to follow-up on a fall incident during which R1 was found face up on the floor at approximately 6:00am on December 13, 2021. Full assessment was conducted and found no injuries, fall mats were ordered. A review of the incident reports submitted to the Orange County Regional Office found no evidence of an incident report being filed following the fall occurrence. As a result of the investigation, the ten allegations listed above are found to be Substantiated, meaning that the preponderance of the evidence standard has been met. Ten citations are issued and documented on attached forms LIC9099-D. An exit interview was conducted, and a copy of this report and appeal information was provided to a facility Administrator Tin Le during the visit. On January 13, 2022, the hospice provider was changed to Bridge Hospice, which had been the R1 provider prior to her relocation at the facility. Resident appraisal established on the same day indicates: "Bedbound, incontinent, paralysis of left arm, dementia" with an indication that resident is "In bed part of the time". Resident assessed as non-ambulatory. There is a physician report on file, with a primary diagnosis of Senile degeneration of the brain as well as a confirmed indication of dementia. The resident was, however, not assessed to be bedridden per the physician who established the report. The physician report is not dated nor signed, so its accuracy cannot be fully verified. Per the death certificate provided, R1 passed away on January 20, 2022. Regarding the allegation that Facility funds are commingled, the following has been concluded: Based on the audit and review of the facility’s funds and finances, funds for two distinct licensed locations “were mixed and transfers between the accounts took place when needed. It’s unclear if funds shifted from Fountain Gardens to cover Cyecrest Home and caused a negative impact on Fountain Gardens’ financial stability”. The audit also demonstrated that according to bank statements reviewed, “the licensee is mixing personal and business expenses”. However, there was no evidence of misappropriation of resident’s funds during the solvency audit conducted. Regarding the allegation that Staff did not administer medication(s) to resident according to their physician's instructions and that Staff did not follow physician's orders for resident in care, the following has been concluded: Paper Medication Administration Records for the period of December 3rd, 2021 until January 1, 2022 have been provided by facility staff and appear to document correct administration in accordance with the physician orders made at the time. Hospice records established by Bridge Hospice for the remainder of January 2022 until R1’s passing also appear to demonstrate adequate medication administration. However, no further verification could be completed after R1’s passing, therefore there is insufficient evidence to either dismiss or corroborate the allegation. Regarding the allegation that Facility Administrator failed to meet administrator requirements, the following has been concluded: Based on a review of the facility’s compliance history in addition to records provided, it has been evidenced that the designated administrator was certified to have completed the Residential Care of the Elderly Administrator Certification Program effective July 26, 2021 and valid until July 25, 2023. Current administrator status verified. CONTINUED ON LIC9099-C Regarding the allegation that Staff did not accurately maintain resident's medical records, the following has been concluded: Following the initial complaint investigation visit conducted on July 19, 2022, the facility’s administrator provided LPA Michelle Reed with resident records via email on July 20, 2022, therefore indicating that at this time records were maintained adequately. The evidence gathered was, however, insufficient to determine whether record keeping was also adequate during R1’s period of admission. Regarding the allegation that Staff did not meet resident's hygiene & toileting needs, the following has been concluded: Based on the assessments conducted upon admission, R1 was diagnosed with bowel incontinence. Hospice staff is documenting that proper perineal care was reviewed with facility staff on December 8, 2021, in addition to hospice care providing resident with a sponge bath. Use of adult diapers documented. Sponge bath and perineal care were also documented on December 13, 15, 17, 20, 22, 24, 27, 29 as well as January 3, 5, 7, 10, 2022. Regarding the allegation that Facility retained a resident who needed a higher level of care, the following has been concluded: Based on the physician report established upon R1’s transfer from Citrus Hills Assisted Living to the present licensed facility, the resident was not assessed to require continuous nursing care which would have been incompatible with R1’s placement in a RCFE. An additional assessment by the Vitas Hospice RN on December 8, 2021, documented that the placement at the board-and-care was sufficient to address R1’s needs in place. On multiple occasions, hospice staff certified an absence of environmental or safety concerns at the facility. Regarding the allegation that Staff did not meet resident's hydration needs, the following has been concluded: Based on a review of hospice records provided by both hospice providers involved in caring for R1 between December 2020 and January 2022, it was evidenced that R1 was diagnosed with “dysphagia following cerebral infarction” as early as December 17, 2020 and first placed under hospice care at that time, with additional documented lack of appetite. Hospice records indicate a fixation upon water and repeated requests for water verbalized by R1 in the days leading to their passing, however no indication is made of a failure from staff to meet hydration needs. Admission report dated January 13, 2022, for Bridge Hospice states “Patient is eating and drinking well per facility staff. (…) Agitation: focused on her son and water. Needs prompt to remain cooperative and calm during the assessment. (…) Intake: 80% of regular size meal. Regarding the allegation that Staff did not notify resident's representative about resident's change in condition, the following has been concluded: CONTINUED ON LIC9099-C Based on hospice notes reviewed for lack of other charting notes from facility staff, R1’s responsible party was aware of the ongoing transition and present at bedside, which appears to indicate some notification had been effected. The party responsible was informed of R1’s decline on multiple occasions, such as on December 22, 2021, when the hospice chaplain became involved. There are, however, two documented interactions in the file provided by facility staff. Due to lack of evidence, the allegation must be found Unsubstantiated. Based on the evidence gathered during the investigation, the nine allegations listed above are found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted, and a copy of this report was provided to Administrator Tin Le during the visit. On January 13, 2022, the hospice provider was changed to Bridge Hospice, which had been the R1 provider prior to her relocation at the facility. Resident appraisal established on the same day indicates: "Bedbound, incontinent, paralysis of left arm, dementia" with an indication that resident is "In bed part of the time". Resident assessed as non-ambulatory. There is a physician report on file, with a primary diagnosis of Senile degeneration of the brain as well as a confirmed indication of dementia. The resident was, however, not assessed to be bedridden per the physician who established the report. The physician report is not dated nor signed, so its accuracy cannot be fully verified. Per the death certificate provided, R1 passed away on January 20, 2022. Regarding the allegation that Resident developed Stage 4 pressure injuries while in care due to neglect, the following has been concluded: Based on a review of resident R1 physician report maintained at the facility, there was a history of skin breakdown assessed upon admission. Due to the absence of name, date and signature on R1’s medical assessment, it cannot be fully relied on to corroborate whether any pressure injuries were present upon admission. However, hospice records provided during the investigation indicate that R1 was admitted on December 3, 2021, with an active hospice admission from December 2, 2021, already indicating the presence of a pressure sore on R1’s coccyx prior to the resident’s move-in at the facility. Hospice plan of care reviewed additionally included bi-weekly wound care, frequent repositioning and a low air loss mattress prior to their initial admission at the facility. Wound care and dressing changes are also regularly documented in the hospice records reviewed. Based on that evidence, the presence and/or appearance of pressure injuries can therefore not be attributed to staff neglect or lack of care provided. The allegation is therefore found to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided to Administrator Tin Le during the visit.the state’s words, verbatim · CDSS document, Mar 24, 2026 · control 22-AS-20220715122629

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Mar 25, 2026

Per CCR 87411(a), “Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs”. This requirement is not met as evidenced by: Based on interviews and records reviewed, there were only two staff on schedule overall for three residents on hospice at the time of the complaint being filed, with no provisions for time off or unscheduled absences. This constitutes an immediate risk to the health, safety and personal rights of individuals in care.the state’s words, verbatim · CDSS document, Mar 24, 2026

Plan of correction: Licensee to provide LIC500 along with staff schedule attesting sufficient staffing coverage by due date 03/25/26.

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.605 · Plan of correction due date: Mar 25, 2026

Per Health and Safety Code, “On and after July 1, 2015, all residential care facilities for the elderly (…) shall maintain liability insurance covering injury to residents and guests (…) caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees”. This requirement is not met as evidenced by: Based on records review, facility insurance coverage lapsed prior to its renewal in February 2022. This constitutes an immediate risk to the health, safety and personal rights of individuals in care.the state’s words, verbatim · CDSS document, Mar 24, 2026

Plan of correction: Licensee agrees to provide the proof of current and adequate liability insurance coverage by due date 03/25/26.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Mar 25, 2026

Per CCR 87213, “The licensee shall have a financial plan (…) that assures sufficient resources to meet operating costs for care of residents”. This requirement is not met as evidenced by: Based on records reviewed, bank statements provided failed to evidence a minimum of three months’ operating costs on hand. This constitutes an immediate risk to the health, safety and personal rights of individuals in care.the state’s words, verbatim · CDSS document, Mar 24, 2026

Plan of correction: Licensee agreed to provide current financial documents attesting to adequate financial planning by due date 03/25/26.

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.72(c) · Plan of correction due date: Mar 25, 2026

Per HSC "bedridden persons may be admitted to, and remain in, residential care facilities for the elderly that secure and maintain an appropriate fire clearance”. This requirement is not met as evidenced by: Based on records reviewed and interviews conducted, R1 was bedbound and unable to reposition independently, which made R1 effectively bedridden. No such provision is allowed is the facility’s fire clearance. This constitutes an immediate risk to the health and safety of individuals in care. CIVIL PENALTY ASSESSED.the state’s words, verbatim · CDSS document, Mar 24, 2026

Plan of correction: Licensee agrees to provide a written statement that no bedridden residents are currently admitted and being provided care by due date 03/25/26.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(c)(1)(A) · Plan of correction due date: Mar 31, 2026

Per CCR 87458(c)(1)(A), “prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment (…) made within the last year, to be kept in the resident's record. (c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis”. This requirement is not met as evidenced by: Based on records reviewed, the medical assessment obtained upon R1’s admission fails to include any information. This constitutes a potential risk to the health, safety and personal rights of individuals in care.the state’s words, verbatim · CDSS document, Mar 24, 2026

Plan of correction: Licensee to review pre-admission requirements and submit a written signed statement of understanding by due date 03/31/26.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87463(b) · Plan of correction due date: Mar 31, 2026

Per CCR 87463(b): “The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition”. This requirement is not met as evidenced by: Based on records reviewed, R1’s change of condition towards active transitioning is not documented. This constitutes a potential risk to the health, safety and personal rights of individuals in care.the state’s words, verbatim · CDSS document, Mar 24, 2026

Plan of correction: Licensee to review reappraisal requirements and submit a signed statement of understanding by due date 03/31/26.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(c)(6) · Plan of correction due date: Mar 31, 2026

Per CCR “The licensee shall maintain documentation pertaining to staff training in the personnel records”. This requirement is not met as evidenced by: Based on records reviewed during the investigation, no initial or annual training was documented. This constitutes a potential risk to the health, safety and personal rights of individuals in care.the state’s words, verbatim · CDSS document, Mar 24, 2026

Plan of correction: Licensee to provide proof of current trainings by due date 03/31/26.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Mar 31, 2026

Reporting Requirements (1) : “A written report shall be submitted to the licensing agency.. within seven days of the occurrence of any of the events.. Any incident which threatens the welfare, safety or health of any resident.. This requirement was not evidenced by: Based on a review of records, the Licensee did not submit an incident report to Community Care Licensing regarding a fall R1 sustained while in care of the facility. This constitutes a potential risk to the health, safety and personal rights of individuals in care.the state’s words, verbatim · CDSS document, Mar 24, 2026

Plan of correction: Licensee agrees to review reporting requirements and provide a written statement of understanding by due date 03/31/26.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a) · Plan of correction due date: Mar 31, 2026

Medical Assessment: “(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record”. This requirement is not met as evidenced by: Based on records reviewed during the investigation, the physician report on file for R1 was not signed. This constitutes a potential risk to the health, safety and personal rights of individuals in care.the state’s words, verbatim · CDSS document, Mar 24, 2026

Plan of correction: Licensee to review medical assessment requirements and submit a signed statement of understanding by due date 03/31/26.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.269(a)(21) · Plan of correction due date: Mar 31, 2026

Enumerated rights; severability (21) “To have prompt access to review all their records and to purchase photocopies. Photocopied records shall be promptly provided, not to exceed two business days, at a cost not to exceed the community standard for photocopies”. This requirement is not met as evidenced by: Based on records reviewed, R1’s authorized representative requested R1’s file on April 18, 2022, and had not received applicable documentation at the time of the present complaint being filed in July 2022. This constitutes a potential risk to the health, safety and personal rights of individuals in care.the state’s words, verbatim · CDSS document, Mar 24, 2026

Plan of correction: Licensee to provide documentation that records were eventually provided to R1’s authorized representative.

Type of visit: Required - 1 Year

On March 24, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit for the purpose of conducting the required annual inspection. LPA was greeted and granted entry by care giving staff after explaining the purpose for the visit. Administrator (AD) Tin Le was notified via telephone and later arrived to assist with the inspection. LPA observed that Tin Le's has a valid Administrator certificate which expires on November 28, 2026. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, and has a hospice waiver for four. The facility is a single story home with five resident bedrooms, one of which is shared, one staff bedroom, three resident bathrooms, a living room, a dining room, a kitchen, and an attached two car garage. LPA, accompanied by the AD, conducted a tour of the interior portion of the facility. On today's visit, LPA observed six residents in care and two care giving staff present. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected all five resident bedrooms and they were observed to be free of any hazards. LPA observed the resident bedrooms had all the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds had clean linens and blankets. LPA observed additional linens are stored in a hallway cabinet. LPA inspected the three resident bathrooms. Resident bathrooms are clean. Resident bathrooms were equipped with grab bars and nonskid floor mats. Faucets and toilets were operational. Hot water temperature measured between 116.7 and 119.8 degrees Fahrenheit. LPA observed the staff bedroom is kept locked and inaccessible to residents in care. LPA observed that the kitchen has a two day perishable and a seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. CONTINUED ON LIC809-C LPA observed the five burner gas stove lights unassisted. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed toxins and chemicals to be stored in a locked kitchen cabinet under the sink. Fire extinguishers are located in the dining room and in the resident hallway. Fire extinguishers were observed to be charged and serviced as of May 5, 2025. LPA tested the smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on March 2, 2026. The centrally stored medication is kept in a locked closet in the living room. LPA observed a first aid kit to be stored in the locked closet and it was observed to have all the required components. LPA observed a fireplace in the dining room and it was observed to be adequately fenced and not in operation at time of visit. LPA observed the door leading to the attached two car garage is kept locked and inaccessible to residents in care. LPA observed the garage to be used for storage. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed the facility has additional chemicals and toxins stored in the garage. LPA, accompanied by the AD conducted a tour of the exterior portion of the facility. LPA observed the exterior portion of the facility to be free of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gates of the facility are self-latching and can be open in an evacuation. There are no bodies of water on the premises. LPA reviewed all six resident files. All the required documentation were present and current in the resident files reviewed. LPA reviewed all six residents' medication and medication administration record. LPA reviewed four staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Tin Le and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 24, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit for the purpose of conducting the required annual inspection. LPA was greeted and granted entry by care giving staff after explaining the purpose for the visit. Administrator (AD) Tin Le was notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Tin Le's certificate expired on November 28, 2024. However, LPA verified and confirmed that Administrator Tin Le submitted an Administrator renewal application to the Administrator Certification Bureau on November 25, 2024. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, and has a hospice waiver for four. The facility is a single story home with five resident bedrooms, one of which is shared, one staff room, three resident bathrooms, two of which are shared, a living room, a dining room, a kitchen, and an attached two car garage. LPA, accompanied by the AD conducted a tour of the interior portion of the facility. On today's visit, LPA observed six residents in care and two care giving staff present. LPA observed the resident relaxing in their respective bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected all five resident bedrooms and they were observed to be free of any hazards. LPA observed the resident bedrooms had all the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds had clean linens and blankets. LPA observed additional linens are stored in a hallway cabinet. LPA inspected the three resident bathrooms. Resident bathrooms are clean. Resident bathrooms were equipped with grab bars and nonskid floor mats. Faucets and toilets were operational. Hot water temperature measured between 119.1 and 119.3 degrees Fahrenheit. LPA observed the staff room is kept locked and inaccessible to residents in care. LPA observed that the kitchen has a two day perishable and a seven day nonperishable food supply on hand. The kitchen is clean and appliances were operational. LPA observed the five burner gas stove lights unassisted. CONTINUED ON LIC809-C LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed toxins and chemicals to be stored in a locked kitchen cabinet under the sink. A fire extinguisher is located in the dining room and in the resident hallway. Fire extinguishers were observed to be charged and serviced as of May 9, 2024. LPA tested the dual smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on December 3, 2024. The centrally stored medication is kept in a locked closet in the living room. LPA observed a First Aid Kit to be stored in the locked closet and it was observed to have all the required components. LPA observed a fireplace in the dining room and it was observed to be adequately fenced and not in operation at time of visit. LPA observed chemicals and toxins to be stored in a locked cabinet in the resident hallway. LPA observed the door leading to the attached two car garage is kept locked and inaccessible to residents in care. LPA observed the garage to be used for storage. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA, accompanied by the AD conducted a tour of the exterior portion of the facility. LPA observed the exterior portion of the facility to be free of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gate on the north side and south side of the facility are self-latching and can be open in an evacuation. There are no bodies of water on the premises. LPA reviewed all six resident files. LPA observed that the Reappraisals for Resident #1 (R1), Resident #3 (R3), and Resident #4 (R4) were outdated. LPA reviewed all six residents' medication and medication record. LPA reviewed two staff files. LPA observed that Staff #1 (S1) and Staff #2 (S2) did not have a Health Screening Report on file. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Tin Le. A copy of the report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Feb 19, 2025