K & J Residential Care Home III

Type of visit: Required - 1 Year

On 03/18/2026 at 10:30 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Direct Care Staff, Mary Ann Garcia, and explained the purpose of the visit. Co-Administrator, Warlita Rivac, arrived shortly after. Administrator certificate is current. Ksai Liang gave authorization for Warlita Rivac to sign the report. LPA toured facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 5 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 115.2 degrees Fahrenheit. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 03/18/2026. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 01/12/2026. At 11:00 AM, LPA reviewed 2 residents records. At 11:21AM, LPA reviewed 3 staff records and 3 of 3 have current first aid training and 2 of 3 associated to the facility. At 2:00 PM, LPA reviewed samples of residents’ medications. Continue to LIC809-C... Continued from LIC809... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 03/26/2026: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Infection Control Plan THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 10:49 AM, LPAs observed unlocked cleaning chemicals such as Lysol Spray, Clorox, medications, scissors, etc. all around the facility. At 11:00 AM, LPAs observed spoiled bell peppers, bread, juices, and other food items with best by dates from 2025. At 11:40 AM, LPA observed that S2 and S3 have incomplete records in the facility. At 11:50 AM, LPAs observed that S3 is not associated with the facility. At 12:41 PM, LPAs observed the freezer in the garage in disrepair, the old patio cushions in trash bags, and one of the rooms without a bed. At 1:42 PM, LPAs observed that R1 does not have doctor's order for their medications and does not have 2 of their medications in the facility. LPAs observed that R2 does not have a doctor's order for all the medications. Continue to LIC809-C... Continued from LIC809-C... At 1:54 PM, record review revealed that there is no liability insurance in the facility file. At 1:58 PM, record review revealed that 2 of 2 residents don't have the Appraisal Needs and Services Plan (LIC625). At 2:00 PM, record review revealed that 2 of 2 residents don’t have a doctor’s order for half bed rail. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with Co-Administrator. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 18, 2026

Type of visit: Prelicensing

On 02/27/2025 at 9:10 AM, Licensing Program Analysts (LPAs) P. Manalo and L. Fontanilla announced to conduct pre licensing inspection. LPAs met with Licensee/Applicant, Ksai Liang and explained the purpose of the visit. The facility has an approved fire clearance for six (6) non-ambulatory. LPAs toured facility with Licensee/applicant including but not limited to 6 bedrooms which 5 bedrooms will be occupied for residents and 1 staff room, 4 bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped built in non-skid shower pan. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 68 degrees Fahrenheit and hot water temperature was maintained at 108 degrees Fahrenheit. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 02/26/2025. The deficiencies from the previous visit have been corrected. This facility is not yet licensed, and is subject to final approval by CAB. Additional requirements may still be required. Exit interview conducted and a copy of this report was provided to Licensee/applicant.the state’s words, verbatim · CDSS document, Feb 27, 2025

Type of visit: Case Management - Other

On 02/27/2025 at 10:20 AM, Licensing Program Analysts (LPAs) P. Manalo and L. Fontanilla arrived announced to conduct Component lll with Licensee/applicant Ksai Liang. LPAs went over with Licensee/ applicant Component lll Power point presentation. LPAs provided applicant with CCLD and LPA contact information. A copy of this report was provided to applicant.the state’s words, verbatim · CDSS document, Feb 27, 2025

Type of visit: Prelicensing

On 02/26/2025 at 8:50 AM, Licensing Program Analysts (LPA) P. Manalo announced to conduct pre licensing inspection. LPAs met with Licensee/Applicant, Ksai Liang and explained the purpose of the visit. The facility has an approved fire clearance for six (6) non-ambulatory. LPA toured facility with Licensee/applicant including but not limited to 6 bedrooms which 5 bedrooms will be occupied for residents and 1 staff room, 4 bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped built in non-skid shower pan. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 58 degrees F and hot water temperature was maintained at 128.3 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 02/26/2025. The following will need to be completed before recommending licensure to Centralized Application Bureau (CAB): At 10:11 AM, LPA observed hot water was measured at 128.3 degrees Fahrenheit in the hallway bathroom sink. At 10:19 AM, LPA observed that there is no adequate shaded area. This facility is not yet licensed, and is subject to final approval by CAB. Additional requirements may still be required. Exit interview conducted and a copy of this report was provided to Licensee/applicant.the state’s words, verbatim · CDSS document, Feb 26, 2025