Golden Shore Care Home

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Marcella Tarin and Coryse Ngangmenyi conducted an unannounced annual inspection and met with Licensee Qing Guo. LPAs stated the purpose of the visit. Licensee states the facility has 6 residents and 3 staff. LPAs toured the interior and exterior of the facility with Licensee to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. All exit and passageways were free and clear of obstruction. The facility was observed to be clean, safe, sanitary and in good repair. LPAs toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPAs observed the refrigerator temperature at 40 F and Freezer at 0 F. LPAs observed the knives as locked an inaccessible to residents. LPAs observed the medication storage area and cleaning product storage area as locked and inaccessible to residents in care. The facility was equipped with smoke and carbon monoxide detectors. The smoke detectors functioned properly when tested by Licensee. Fire extinguishers were observed as fully charged. LPAs reviewed the facility first aid kit, and it was observed to be complete. The facility emergency drill log was reviewed. The facility's last drill was conducted on 7/1/2026. Page 1 of 2 LPAs toured 6 resident bedrooms with the Licensee. All 6 resident rooms have a bed, functioning lights, dresser/table, bedding and space for personal belongings. LPAs toured 4 bathrooms. All 4 bathrooms had hand soap, paper towels, functioning lights, and covered trash bins. LPAs measured water temperature with a range of 105 F to 110.1 F in 3 out of 4 bathrooms. 1 Bathroom water temperature measured at 82.5 F in Bedroom #6. A Technical Violation was issued. During tour of resident rooms, LPAs observed two pairs of gloves on the counter, which appeared to be used. Licensee placed the gloves in the trash can. A Technical Violation was issued. LPAs reviewed 6 resident records. LPAs observed 1 Resident (R1) did not have a current copy of his/her hospice care on file. R1's hospice care plan is dated for 2025. Licensee was advised to ensure a current and complete hospice care plan shall be maintained in the facility for each hospice resident. A Technical Violation is being issued. LPAs reviewed 6 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPAs reviewed 3 staff records. No deficiencies were cited, Technical Violations were issued, see LIC9102 for more information during today's visit per California Code of Regulations Title 22. An exit interview was conducted with Licensee Qing Guo and a signed copy of this report was provided. Page 2 of 2 END OF REPORTthe state’s words, verbatim · CDSS document, Jul 10, 2026

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Qing Guo. During the visit, LPA observed 4 residents and 3 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 4 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 observed the storage shed in the backyard being used as storage. 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 75 degrees F, and hot water temperature was measured to range from 112-114 degrees F in resident bathrooms. Fire extinguisher was serviced in October 14, 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 June 10, 2025. LPA reviewed 2 resident medications and centrally stored medication records. LPA conducted interviews with 2 staff and 2 residents. Page 1 Out of 2. LPA reviewed facility records for 2 staff and 2 residents. Based on a review of R1's Physician's report, dated April 23, 2025, R1 has a neurocognitive disorder. R1's Needs and Service plan is dated July 16, 2021. Facility ADM stated she has not updated R1's Needs and Services plan. Based on a review, R2's Physician's report is dated May 28, 2023. R2's Needs and Services Plan is dated June 3, 2023. LPA asked ADM if she has an updated Needs and Services Plan for R2, ADM stated no. LPA asked ADM if she requested a new physician's report for R2. ADM stated she did not. LPA asked if resident R2 refused to see his/her doctor, ADM stated no. ADM stated she did not ask the family of R2 to get an updated physician's report. LPA provided ADM with PIN 24-09-ASC Updated Dementia Care and Miscellaneous Regulations for Residential Care Facilities for the Elderly & PIN 25-05-ASC Updated Medical Assessment for Residential Care Facilities for the Elderly (LIC 602A) Form, including a copy of the new updated LIC602A form. Deficiencies cited during today's visit. This report was reviewed with Administrator Qing Guo and a copy of the signed report was provided. Appeal rights were provided. Page 2 Out of 2. END OF REPORTthe state’s words, verbatim · CDSS document, Jun 27, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Qing Guo. During the visit, LPA observed 6 residents and 2 staff. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 4 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 observed the storage shed in the backyard being used as storage. 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 72 degrees F, and hot water temperature was measured to range from 109-111 degrees F in resident bathrooms. Fire extinguisher was serviced in October 9, 2023. 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 05/15/2024. LPA requested to review the 3rd & 4th quarter drill in 2023 and the 1st quarter drill in 2024. ADM stated she conducted the drills but could not produce documentation showing the drills had been conducted. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 2 staff and 2 residents. A Deficiency is being cited during today's visit. This report was reviewed with Administrator Qing Guo and a copy of the signed report was provided. Appeal Rights were provided.the state’s words, verbatim · CDSS document, Jun 6, 2024