Harmony One Care Home

Type of visit: Case Management - Other

At approximately 11:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a case management visit to follow up on deficiencies observed during the annual inspection on 03/09/2026. LPA met with Licensee Stanley Wong. LPA reviewed the previous areas of concern and observed the items remain in compliance. During this inspection, LPA observed two individuals living in a staff room. LPA was informed they have been present and working the morning shift for approximately one month. Neither individual were listed on the facilities background check roster. An immediate civil penalty is being issued in the amount of $100 per day for 5 days for each individual, totalling $1,000. Licensee informed LPA that they have not received their required 40 hours of initial training. During this visit LPA observed residents sleeping in the living room with the blinds closed and soft music playing. LPA discussed regulation regarding planned activities with Licensee. LPA spoke with Licensee about the Departments Technical Support Program. Licensee expressed interest in receiving assistance with Administrator responsibilities, Staff and Resident record keeping. LPA provided copies of Regulations 87355, Criminal Record Clearance, 87412, Personnel Records, Direct Care staff training requirement documentation and 87219, Planned Activities. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Stanley Wong and appeal rights were given.the state’s words, verbatim · CDSS document, May 8, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: May 9, 2026

Criminal Record Clearance- 87355(e)(1)- All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, 2 staff were living in a staff room and did not have a background clearance or associated to the building. This poses an Immediate Health, Safety or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, May 8, 2026

Plan of correction: Licensee agrees to ensure all staff receive a criminal records clearance prior to working or residing at the facility. Licensee shall submit evidence of a cleared background clearance and association to the facility by 05/09/2026.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.625(b)(1) · Plan of correction due date: May 29, 2026

1569.625 Staff training; legislative findings; contents: (b) (1) The department shall adopt regulations to require staff members of residential care facilities for the elderly...This training shall consist of 40 hours of training. This requirement is not met as evidenced by: Based on interviews conducted, Licensee did not provide new staff the required number of training hours. This poses a potential Health, Safety or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, May 8, 2026

Plan of correction: Licensee agrees that all new staff shall receive the required training hours prior to working on their own with residents. Licensee shall submit evidence of completed staff training for S1 and S2 by 05/29/2026.

Type of visit: Required - 1 Year

At approximately 8:15AM, Licensing Program Analyst (LPA) Chris Arnhold made an unannounced annual required inspection of this licensed senior care facility. LPA met with House Manager Will Praiphetsak. At approximately 8:45AM, LPA toured the building and grounds which was found to be clean and orderly. LPA observed the back deck ramp has a potential trip hazard at the base, where the boards are raised and the concrete is crumbling. The emergency exit gate was observed to be tied closed with string, preventing it from being opened. This is a repeat violation within a 12 month period. An immediate civil penalty is being issued in the amount of $1000. All notices that are required to be posted have been posted and are in a highly visible area. LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored in a locked storage closet. Water temperature measured within regulation between 105 and 120 degrees F at faucets accessible to residents. Fire extinguishers inspected were charged. Smoke detectors in the living room, hallway and one residents room had their batteries disconnected. This is an immediate Safety risk to residents in care. An immediate civil penalty is being issued in the amount of $500. Staff replaced batteries during visit and alarms were functional. Carbon Monoxide detectors were present. There was enough lighting in all common areas, resident rooms, and hallways. Most medication is centrally stored and secure, however, a bottle of vitamins was stored in the dining room cupboard, which is easily accessible. LPA observed cleaning solutions stored, unsecured, under each of the two resident bathroom sinks. At approximately 9:00AM, LPA reviewed 7 of 7 resident records and found 3 of 7 residents have not had a physician visit within the last 12 months. LPA observed 2 of 7 residents did not have current appraisals during this visit. LPA spoke with Licensee about physician reports and the requirements of when they need to be updated during the Post Licensing visit on 07/07/2025. LPA provided copies of regulation pertaining to resident records and incidental medical topics during that visit and issued a technical violation at the time. LPA reviewed medication records and observed there were no centrally stored medication lists for any resident. Medication was prepared for the day in small containers. Continued on LIC 809-C... LPA observed one pill container from the AM medication pass still contained pills. After breakfast, R1 went back to sleep and did not take morning medication. Staff did not notify residents physician, and were going to give the medication when they woke. LPA provided instruction on medication time frames and reporting. At approximately 11:15AM, LPA was not able to review staff records as they were not present at the facility. This is a repeat violation in a 12 month period. An immediate civil penalty is being issued in the amount of $250. Evidence of current first aid and CPR training were current. LPA interviewed 2 staff during this inspection. At approximately 12:00PM, LPA reviewed facility disaster plan. Staff did not appear to have a good understanding of disaster procedures and what to do in an emergency. House manager was able demonstrate where gas and water shutoffs were and how to operate. LPA reviewed the emergency drill log and found the last drill was conducted 07/24/2025. This is a repeat violation within in a 12 month period. An immediate civil penalty is being issued in the amount of $250. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: Evidence of control of Property, (Current Rental/Lease Agreement/Deed) LIC308- Designation of Facility Responsibility LIC500- Personnel Report LIC610E- Disaster Plan Updated Facility Sketch showing Ambulatory status of each room Evidence of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Will Praiphetsak and Appeal rights were given.the state’s words, verbatim · CDSS document, Mar 9, 2026

The state marks this report as 18 pages; the online copy we transcribed has 9. You can request the full file from the county licensing office.

Type of visit: Post Licensing

At approximately 8:15AM, Licensing Program Analyst (LPA) Chris Arnhold made an unannounced Post Licensing Visit of this licensed senior care facility. LPA met with Licensee Stanley Wong. At approximately 8:45AM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed interior walkways and exits to be unobstructed, however, the exit gate was broken and did not open to allow evacuation. Licensee corrected the gate during visit. All notices that are required to be posted have been posted and are in a highly visible area. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored in a locked storage closet. Water temperature measured above regulation between 105 and 120 degrees F at faucets accessible to residents. Licensee adjusted hot water temperature during visit. Fire extinguishers inspected were charged. All smoke detectors were found to have their batteries disconnected. Staff reinstalled the batteries during visit. Carbon Monoxide detectors were present. Facility had the proper lighting in all common areas and resident rooms. There were no night lights in the hallway leading to the bathroom. Medication is centrally stored and secure. At approximately 9:15AM, LPA reviewed 6 resident records. LPA found 5 of 6 residents did not have current physician's reports or care plans. 6 of 6 records contained current and signed admission agreements. Medication records were present. Two residents were receiving Hospice Services but there were no hospice care plans or documentation present. Licensee did not have staff records present at the facility during this visit. Continued on LIC809-C... At approximately 11:00AM, LPA reviewed the facility emergency disaster plan. Facility has a generator to supply power during an outage. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility has not conducted or documented a disaster drill in the last 4 months. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Stanley Wong and Appeal rights were given.the state’s words, verbatim · CDSS document, Jul 7, 2025

The state marks this report as 10 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Prelicensing

At approximately 10:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived announced to conduct a Pre-licensing Facility Inspection with applicant Stanley Wong. Facility has received fire clearance for six non-ambulatory residents and 1 ambulatory resident. Facility has included Dementia Care in the Plan of Operation but will not be advertising for dementia. Facility is a single-story home. Resident's bathrooms are located in common hallway. Night light was present in hallway. Grab bars and nonskid mat were present. Hot water temperature in resident's bathrooms was within regulation. Medications are centrally stored and locked. Kitchen appliances, utensils, and food preparation areas are in good condition. Seven day supply of non-perishable food was present. Knives are secured in kitchen drawer. Stove knobs can be easily removed when stove is not in use. Toxins and cleansers are locked in garage and in kitchen & bathroom cabinets under sink. Fire extinguishers were charged and current. Smoke detectors are operational. Carbon Monoxide detector was present. Windows, doors, walls, ceilings, screens, ramps, paint, and furniture are in good condition. Resident records are stored in a secure cupboard. Staff present had current first aid and CPR training. Component III orientation was conducted during this visit. Applicant has secured a quote for Liability insurance and will forward a copy upon receiving their License. Based on the findings during this inspection Applicant is ready to be Licensed. LPA will submit the application for a final review from the Licensing Program Manager.the state’s words, verbatim · CDSS document, Mar 28, 2025

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 7 Census (if any clients in care): 7 Interview Method: Telephone interview On 3/19/2025, applicant/administrator participated in COMP II. Identification of the applicant / administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant / administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Mar 19, 2025