Hampton Guest Home

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Tao and Mallett conducted an unannounced annual visit at the facility using the CARE inspection tool. LPAs met with Staff#1 upon arrival and Administrator Jeffrey Yang join shortly after. LPAs explained the reason for the visit to Administrator. Facility annual fees are current. Liability insurance coverage is current which covers from 06/28/25 – 06/28/26. This facility is licensed to serve six (6) non-ambulatory residents, age 60 and above and have one (1) hospice waiver approved. Dementia waiver is in place. Today’s inspection consisted of applying CARE tool, conducting physical plant, reviewing staff/residents records, checking residents’ food supply/medication, and interviewing staff/residents. Infection Control: Facility maintains an infection control plan was on file. Staff were observed practicing safe hand washing. Hand sanitizing was observed throughout. Hygiene supply and sanitizing materials were observed in each bathroom and changing station. (-continued on LIC 809C-) Physical Plant & Environmental Safety: The facility consists of an administrator office room, kitchen, living room, family room, dining room, six (6) resident bedrooms, one (1) staff bedroom, three (3) resident bathrooms, one (1) staff bathroom, a detached garage, a front yard, and backyard. Physical plant was conducted and observed the facility is in good repair indoor and outdoor. Facility is operating within capacity. A swimming pool was observed in the backyard which is secured with a 5ft fence with a locked gate and not accessible to the residents. Cleaning supplies and sharp materials were observed locked and inaccessible to clients. Outdoor space is furnished, shaded, and accessible to residents. Passageways and exit areas were observed free of obstructions. Restrooms were observed clean. Water temperature was tested within 107 - 108.7 degrees F., which is within the required 105-120 degrees F per Title 22 requirement. Staff/ Residents Records review: Administrator certificate is current, and the expiration date is 12/01/27. Staff and residents’ records were reviewed but files were incomplete. See LIC 809 D for citation details. Food Service: The kitchen was clean. The required two (2) days of perishable and seven (7) days of nonperishable were observed and stored separately from toxic/cleaning supply. (-Continued on LIC 809C-) Health-Related Services: Medications were reviewed. Medications are centralized stored and inaccessible to the residents. First aid kit was reviewed. Incidental Medical Services: Facility does not currently serve any residents with restricted health conditions. Disaster Preparedness: Emergency Disaster Plan LIC610E was observed and last reviewed on 2/07/25. A contingency plan was observed. Last emergency drill was conducted on 01/30/26. Exit: Deficiencies were noted during this visit and cited per California Code of Regulations, Title 22, Division 6. Exit interview was conducted with Administrator Jeffrey and LIC 809s and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 30, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Jeffrey Yang and explained the reason for the visit. The facility is licensed to serve 6 non-ambulatory residents age 60 and above. Facility has a dementia waiver and are allowed to care for 1 resident on hospice at any one time. The facility is a single-story home, located in a residential area. It consist of; an administrator office room, kitchen, living room, family room, dining room, 6 resident bedrooms, 1 staff bedroom, 3 resident bathrooms, 1 staff bathroom, a detached garage, a front yard and backyard. LPA reviewed the following CARE inspection tool domains during this visit: Infection Control: Infection control plan was reviewed which meets current regulations. Hand sanitizer and proper sanitation was observed during the visit. Each staff has a current TB test. There is a responsible person and emergency training was provided to staff. Personal protective equipment was observed. Operational Requirements: Facility maintains a plan of operation. Facility has a current liability insurance. Facility is operating within the license. Physical Plant/Environmental Safety: LPA conducted a tour of the facility with Jeffrey Yang and observed the following: Facility was observed in good repair indoors and outdoors. Living room/family room/dining room are all clean, and providing sufficient sitting area, and lighting.A fireplace was observed in the living room covered. Kitchen area is clean, sharps were observed locked in a drawer. Each resident room (6) were observed clean with sufficient lighting, furniture, and bedding supplies. Bathrooms (3) were observed clean in working condition with grab bars and skid mats in the showers. Water temperature was tested in each bathroom and tested between 106.3 - 111.0 degrees F., which is within the required 105-120 degrees F. Garage is used to stored cleaning supplies, laundry area is located in garage and it is not accessible to the residents. (CONTINUED ON LIC 809C) Backyard has shaded sitting area and a 5ft fence surrounds the pool making it inaccessible to the residents. Carbon Monoxide/Smoke detectors were observed, tested, and in working condition. Fire extinguishers were observed and last checked on 12/6/23. Ramps, exit doors, and passageways are free of debris and obstructions. Staffing: Jeffrey Yang is the appointed facility manager designated. Staff have current CPR/First Aid training on file. Night staff have been provided with emergency training. Sufficient staff were observed. Personnel Records/Staff Training: Administrator certificate was observed for Jeffrey Yang #7002701740 exp. date: 12/1/25. All staff records were available for review. LPA reviewed a total of 4 staff files which included medical assessment, TB clearance, background clearance, and training. Staff training files were not on file for the last 20 hours of yearly training. Resident Rights/Information: Personal Rights, Let Us No poster (PUB 345), and Local Ombudsman posters were observed throughout the home. Planned Activities: Activity materials were observed. Activities were provided during the visit. All residents were involved. Outdoor area has a seating area to promote outdoor activities. Food Service: Sufficient food supplies were observed of perishables for at least 2 days and non-perishables for at least 7 days. Staff are familiar with special diets identify by residents' physicians. No pest was observed. Incidental Medical and Dental: All medication is centrally stored in the living room in a lock cabinet. Medications are label and in their original containers. PRN medication dispensed is recorded in a log. Resident Records/Incident Reports: Residents records were available for review. LPA reviewed a total of 5 resident files which contained medical assessment, TB clearance, admission agreement, an appraisal, a needs and care plan. Disaster Preparedness: Emergency Disaster plan (LIC 610D 3/19) was last reviewed on 2/7/25. Emergency drills are conducted quarterly and the last emergency drill was conducted on 1/29/25. Residents with Special Health Needs: Postural support/bed rails were observed and physician's request were observed in residents files. There are no residents with restricted health conditions under care. Facility is following dementia regulations. Medical assessments for 2 residents with dementia were observed not within the last 12 months. Staff have requested the assessment and are pending. Auditory devices were observed in each exit door. Facility currently has one resident on hospice and keeps hospice plan on file. No deficiencies were noted during this visit. Technical violations were noted. Exit interview was conducted with Jeffrey Yang and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 18, 2025

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Jeffrey Yang and explained the reason for the visit. The facility is licensed to serve 6 non-ambulatory residents age 60 and above. Facility has a dementia waiver and are allowed to care for 1 resident on hospice at any one time. The facility is a single-story home, located in a residential area. It consist of; an administrator office room, kitchen, living room, family room, dining room, 6 resident bedrooms, 1 staff bedroom, 3 resident bathrooms, 1 staff bathroom, a detached garage, a front yard and backyard. LPA conducted a tour with Jeffrey Yang and observed the following: Facility was observed in good repair indoors and outdoors. Living room/family room/dining room are all clean, and providing sufficient sitting area, and lighting. Medication cabinet was observed locked in the living room, and fireplace was observed covered. Kitchen area is clean, sharps were observed locked in a drawer. Sufficient food supplies were observed of perishables for at least 2 days and non-perishables for at least 7 days. Each resident room (6) were observed clean with sufficient lighting, furniture, and bedding supplies. Bathrooms (3) were observed clean in working condition with grab bars and skid mats in the showers. Water temperature was tested in each bathroom and tested between 106.7-112.8 degrees F., which is within the required 105-120 degrees F. Garage is used to stored cleaning supplies, and laundry area and it is not accessible to the residents. Backyard has shaded sitting area and a 5ft fence pool inaccessible to the residents. Carbon Monoxide/Smoke detectors were observed, tested, and in working condition. Fire extinguishers were observed and last checked on 12/6/23. Ramps, exit doors, and passageways are free of debris and obstructions. LPA reviewed files and medication for 5 residents and 3 staff. Resident #5(R5) does not have a current physician's report last dated 7/28/22 and no TB clearance on file. Resident #4(R4)'s physician's report notes resident as bedridden. Files for staff #4-5 (S4-S5)were not available for review at the time of the visit, no proof of TB clearance for S4-S5. (CONTINEUD ON LIC 809C) S4 is night staff no current First aid training on file. No training records for any staff within the last 12 months. Emergency Disaster plan and Infection Control plan were reviewed no record on when they were last update observed. Last emergency drill was conducted on 8/1/21. Administrator certificate was submitted for renewal on 8/22 for Jeffrey Yan # 6009748740 exp. date: 12/2/23 pending approval. Change of administrator was discuss and Mrs. Erlinda Yang will not be returning as the administrator. Mr. Yang will submit the requested documents by 3/8/24. Deficiencies are noted on LIC 809D per Title 22 Regulations. *Immediate $500 civil penalties have been assess for fire clearance* Fire Department was notified via telephone (message only) of bedridden residents (2) at the facility on 2/28/24. Exit interview was conducted with Jeffrey Yang and a copy of this report, LIC 809D, and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 29, 2024

The state marks this report as 9 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.