Kimochi San Mateo

Type of visit: Case Management - Annual Continuation

To complete annual inspection of 5/27/26, LPA Jeung reviewed staff training records provided, and met with assistant administrator. Clients' Centrally Stored Medications Records are reviewed today and observed to be accurately documented.. Based on staff training transcripts provided on 5/27/26, deficiencies of the California Code of Regulations, Title 22 are cited on a following page.the state’s words, verbatim · CDSS document, Sep 9, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.625(b)(2) · Plan of correction due date: Sep 23, 2026

HEALTH & SAFETY CODE ... training requirements shall also include an additional 20 hours annually, 8 hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, & 4 hrs of which shall be specific to postural supports, restricted health conditions, & hospice care, as required by subdiv (a). This requirement is not met, as 2 out of 3 care staff have not received required 8 hours of annual dementia training. Licensee failed to ensure that caregivers receive required annual dementia training, which poses a potential health, safety or personal rights risk to clients in care. S1 need additional 3 hours & S3 needs additional 4 hours of dementia training.the state’s words, verbatim · CDSS document, Sep 9, 2026

Plan of correction: Proof of additional required annual dementia training for staff #1 and staff #3 will be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569,696(a)(2) · Plan of correction due date: Sep 23, 2026

HEALTH & SAFETY CODE All RCFEs shall provide training to direct care staff on postural supports, restricted conditions or health services, and hospice care as a component of the training requirements specified in Section 1569.625... Four hours of training thereafter of in-service training per year on the subject of serving those residents. This requirement is not met, as 3 out of 3 staff have not received required 4 hours of annual training on postural supports, restricted conditions or health services, and hospice care. Licensee failed to ensure that caregivers receive required annual training. S1 needs additional 1.5 hours, S2 needs additional 2.5 hours, and S4 needs 4 hours of training.the state’s words, verbatim · CDSS document, Sep 9, 2026

Plan of correction: Proof of additional required annual training on postural supports, restricted health conditons and hospice care for staff #1, #2, #4 will be sent to CCLD BY DUE DATE

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds, consisting of 11 client bedrooms--3 of which are shared--all with full private bathrooms. All but 3 rooms have direct access to enclosed paved patio. No accessible bodies of water or fire safety hazards observed. PPE supply is adequate and first aid kit is complete. Perishable and non-perishable food supply is maintained. Infection control signs are prominently posted. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Hot water temperature is tested. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Liquid soap is available at all sinks. A Disaster and Mass Casualty Plan is accessible to staff. There are 2 caregivers working. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. Linda Ishii-Chan and Bhawana Shah are certified RCFE administrators (x3/28 and 7/27) that oversee facility operations. There are two bedridden residents, one of whom is receiving hospice care. Staff and client files are reviewed. Training transcripts are provided to LPA for review. Centrally stored medication records may be reviewed at a later date. The following updated forms/information are requested to be submitted to CCLD BY 6/10/26: • Proof of current Liability Insurance • Administrative Organization (LIC309) • Designation of Facility Responsibility (LIC308) • Updated facility sketch, including correct room numbers Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on a following page. See also Technical Advisiory Notes--4 pages.the state’s words, verbatim · CDSS document, May 27, 2026

Type of visit: Case Management - Annual Continuation

To complete annual inspection of 4/24/25, LPA Jeung reviewed staff records--including training--and Centrally Stored Medications Records. Deficiencies of the California Code of Regulations, Title 22 are cited on following pages.the state’s words, verbatim · CDSS document, Apr 29, 2025

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds, consisting of 11 client bedrooms--3 of which are shared--all with full private bathrooms. All but 3 rooms have direct access to enclosed paved patio. No accessible bodies of water or fire safety hazards observed. PPE supply is adequate and first aid kit is complete. Perishable and non-perishable food supply is maintained. Infection control signs are prominently posted. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Hot water temperature is tested at 119 degrees in bathroom in room #2. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Liquid soap is available at all sinks. A Disaster and Mass Casualty Plan is accessible to staff. There are 2 caregivers working. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. Linda Ishii-Chan and Bhawana Shah are certified RCFE administrators (x3/26 and 7/25) that oversee facility operations. Client files are reviewed. There are 2 clients receiving hospice care. Staff files will be reviewed at a later date. The following updated forms/information are requested to be submitted to CCLD BY 5/8/25: • Proof of current Liability Insurance • Hospice plan of operation • Bedridden plan of operation • Updated facility sketch, including correct room numbers Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on a following page. See also Technical Advisiory Notes--4 pages.the state’s words, verbatim · CDSS document, Apr 24, 2025

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds, consisting of 11 client bedrooms, 3 of which are shared--all with full private bathrooms. All but 3 rooms have direct access to enclosed paved patio. No accessible bodies of water or fire safety hazards observed. PPE supply is adequate and first aid kit is complete. Perishable and non-perishable food supply is maintained. Infection control signs are prominently posted. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Hot water temperature is tested at 120 degrees in public bathroom. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Liquid soap is available at all sinks. An updated Disaster and Mass Casualty Plan is accessible to staff. There are 13 residents present, and 2 caregivers. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. Linda Ishii-Chan is a certified RCFE administrator that oversees facility operations. Staff and client files are reviewed. The following updated forms/information are requested to be submitted to CCLD BY 7/1/24: • LIC 309 Administrative Organization • LIC 308 Designation of Administrative Responsibility • LIC 500 Personnel Report The following information is provided to LPA: • Proof of current Liability Insurance • Page 9 of Emergency Disaster Plan (LIC610E) Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on a following page. See also 2 Technical Advisiory Notes.the state’s words, verbatim · CDSS document, Jun 17, 2024