Garden Home

Type of visit: Required - 1 Year

At approximately 8:30AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1 Year Required visit and met with Staff Members, Elsa Bacsal and Mary Wang. Administrator, Tom Yuan, arrived during visit at approximately 9:00AM. Licensee, Sherry Zhu, arrived during visit at approximately 9:20AM. Facility is a Residential Home for the Elderly that provides care and assistance for Older Adults with Disabilities. Facility has an approved fire clearance and capacity for 4 Non-Ambulatory Residents. Facility has a hospice waiver for 1 individual. Upon arrival, LPA was informed that there were 4 residents in care, with 2 residents preparing to leave for their Day Program. LPA was also informed that there were 2 staff members on site. At approximately 8:45AM, LPA reviewed the Facility's Staff Roster and found that all staff on site were background cleared and associated to the facility per regulation. LPA conducted a walk-though of the facility with Administrator. LPA observed the following: Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a one story building with 4 resident bedrooms, 2 bathrooms, and common spaces. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Mattress pads were in place or available for resident use. Toxins were observed to be stored inaccessible to residents. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. During walkthrough, LPA observed that facility had multiple instances of expired foods in facility fridge and freezer including tofu and Costco prepared meals. LPA, Administrator, Licensee discussed checking foods to ensure that food stays safe for consumption. Administrator's Certificate for Tom Yuan (7003584740) was current with an expiration date of 05/19/2026. Fire extinguishers were last inspected June 2026. Smoke detectors and carbon monoxide detectors were tested and operational. Facility's last emergency/disaster drill was conducted July 2026. Facility's emergency disaster plan was last reviewed and updated May 2025 and infection control plan were last reviewed and updated June 2025. Facility did not have Continued LIC809C Continued from LIC809 an adequate supply of emergency water accessible in the event they needed to shelter in place for 72 hours. LPA reviewed staff files, resident files, resident medication. All files were all found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. Resident files had updated resident assessments and appraisals. LPA observed that facility tracks staff annual training by using a training checklist. LPA, Licensee, and Administrator discussed their annual training checklist and ensuring it is fully completed with signatures and dates by a staff member's date of hire. LPA discussed with Licensee and Administrator on ensuring that resident appraisals address behavioral expressions if they have been identified in resident medical assessments. During medication review it was observed that the pharmacy sends a completed LIC622/Central Storage Log to the facility. It was observed that there was incorrect information on the LIC622 from the pharmacy such as expiration date and number of refills. LPA, Licensee, and Administrator discussed reviewing the LIC622 completed by pharmacy to ensure its accuracy. LPA also discussed the following with Licensee and Administrator: Reporting Requirements PIN regarding 911 protocols LPA requested the following documents to update facility file: Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610E) Updated Personnel Report (LIC 500) Updated Liability Insurance Active and Current Administrator Certificate Documents to be submitted to Community Care Licensing (CCL) by due date of 8/10/2026. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiencies, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC809D (Deficiency Page), LIC9102 (Technical Advisories/Violations), Plan of Corrections, and Appeal Rights discussed and provided to Licensee and Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jul 10, 2026

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At approximately 9:15AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1 Year Required visit and met with Staff Members, Elsa Bacsal and Lisa Lin. Administrator, Tom Yuan, arrived during visit at approximately 9:50AM. Facility is a Residential Home for the Elderly that provides care and assistance for Older Adults with Disabilities. Facility has an approved fire clearance and capacity for 4 Non-Ambulatory Residents. Upon arrival, LPA was informed that there were 4 residents in care, with 2 residents out of the community attending Day Program. LPA was also informed that there were 2 staff members on site. At approximately 9:20AM, LPA reviewed the Facility's Staff Roster and found that all staff on site were background cleared and associated to the facility per regulation. LPA conducted a walk-though of the facility with Staff Member. LPA observed the following: Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a one story building with 4 resident bedrooms, 2 bathrooms, and common spaces. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Mattress pads were in place or available for resident use. Toxins were observed to be stored inaccessible to residents. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Administrator's Certificate for Tom Yuan (7003584740 was current with an expiration date of 05/19/2026. Fire extinguishers were last inspected May 2025. Smoke detectors and carbon monoxide detectors were tested and operational. Facility's last emergency/disaster drill was conducted April 2025. LPA reviewed staff files, resident files, resident medication, and resident P&I monies. Continued on LIC809C Continued from LIC809 All files were all found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. Medication was centrally stored and secure. P&I monies were documented, secure and not commingled. LPA requested the following documents to update facility file: Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610E) Updated Personnel Report (LIC 500) Updated Liability Insurance Active and Current Administrator Certificate Documents to be submitted to Community Care Licensing (CCL) by due date of 7/05/2025. No Deficiencies Cited during visit. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jun 5, 2025

Type of visit: Required - 1 Year

At approximately 12:15PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1 Year Required visit and met with Staff Member, Elsa Bacsal. Administrators, Tom Yuan and Sherry Zhu arrived during visit at approximately 12:45PM. Facility is a Residential Home for the Elderly that provides care and assistance for Older Adults with Disabilities. Facility has an approved fire clearance and capacity for 4 Non-Ambulatory Residents. Upon arrival, LPA was informed that there were 4 residents in care, with 2 residents out of the community attending Day Program. LPA was also informed that there were 2 staff members on site. At approximately 12:30PM, LPA reviewed the Facility's Staff Roster and found that all staff on site were background cleared and associated to the facility per regulation. At approximately 12:35PM, LPA conducted a walk-though of the facility with Staff Member. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a one story building with 4 resident bedrooms, 2 bathrooms, and common spaces. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Mattress pads were in place or available for resident use. Toxins were observed to be stored inaccessible to residents. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Administrator's Certificate for Xiaotong (Sherry) Zhu (6003088740) currently pending. Fire extinguishers were last inspected May 2024. Smoke detectors and carbon monoxide detectors were tested and operational. Facility's last emergency drill was conducted in July 2024. LPA reviewed staff files, resident files, resident medication, and resident P&I monies. All files were all found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. Medication was centrally stored and secure. P&I monies were documented, secure and not commingled. Continued on LIC809C Continued from LIC809 LPA requested the following documents to update facility file: Affidavit regarding Client/Resident Cash Resources (LIC 400) Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610D) Updated Personnel Report (LIC 500) Surety Bond (LIC 402) Updated Liability Insurance Active and Current Administrator Certificate Documents to be submitted to Community Care Licensing (CCL) by due date of 8/29/2024. No Deficiencies Cited during visit. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jul 29, 2024