Lilly's Care Home

Allegation investigated: Facility staff providing night shift does not have first aid/CPR training

Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegations. LPA met with Administrator Lilly Li On May 1, 2026, the Department received a complaint alleging Facility staff providing night shift does not have first aid/CPR training On May 7, 2026, the Department interviewed Administrator (ADM) Lilly Li. ADM stated all her employees have completed their first aide. ADM stated she would provide a copy of the fist aide to LPA. Page 1 Out of 2. Unfounded On May 7, 2026, Licensing Program Analyst Manuel Monter reviewed/audited all staff members 6 Out of 6 staff, including Administrator Lilly Li has completed and current first aid training. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Page 2 Out of 2. End of Report. LPA asked S1 how many residents live in the home. S1 made multiple attempts with his/her translation app. S1 was not able to answer the question. LPA had to re-phrase the question multiple times for S1 to understand the question. S1 was then able to answer, stating there are 6 residents in the home. LPA asked S1 what he/she would do if a resident sustained a fall. LPA asked S1 not to use the translation app. S1 gestured that he/she wasn’t able to answer. S1 then used his/her translation app. S1 responded via translation app that he/she would call the hospital immediately. LPA asked S1 if he/she could show LPA what he/she would say when contacting 911 and how he/she would do it. S1 stated he/she uses his/her translation app. LPA made multiple attempts to ask S1 what he/she would say to emergency services in response to a fall or a fire, but S1 wasn’t able to provide an answer besides reiterating via translation app that he/she would call the hospital calling the hospital immediately or call the administrator. LPA asked S1 if paramedics asked for Polst, would he/she know what that is. S1 wasn’t able to respond to question using his/her translation app. LPA brought a residents centrally stored medication record to S1. LPA asked S1, if emergency responders asked, would he/she be able to answer what medications a resident was taking. S1 was not able to answer the question. On May 7, 2026, Licensing Program Analyst Manuel Monter interviewed Administrator Lilly Li. LPA asked ADM if staff S1 can communicate with emergency responders. ADM stated she is the one who communicates with emergency responders. LPA informed ADM based on interview conducted with S1, he/she was not able to show LPA how he would communicate with emergency services during an emergency. ADM stated she lives 5 minutes away from the home. ADM stated if anything happens, S1 will contact her first. LPA informed ADM that her staff needs to be able to have the ability to communicate with emergency services. LPA informed ADM that there a multitude of possibilities where the ADM isn’t available. LPA informed ADM that the staff at the home needs to be able to and have the ability to contact 911 if an emergency occurs. ADM agreed that this could be an issue. Page 2 Out of 3. ADM stated because S1 isn’t able to verbally communicate, she would be the one who would do the communicating. ADM stated during an emergency situation, S1 would contact her. ADM acknowledged S1, being the only staff member in the home, during NOC shift, and not being able to communicate without the assistance of ADM, who doesn’t live in the home, is an issue. On May 18, 2026, Licensing Program Analyst Manuel Monter interviewed staff S3. S3 was able to answer questions posed by LPA and was able to described what he/she is supposed to do in emergency situations. Based on interviews and documents review the preponderance of evidence standard has been met therefore the above allegations is found to be SUBSTANTIATED. Deficiencies cited during today's visit. See LIC9099-D. This report was reviewed with Administrator Lilly Li. Appeal rights were provided. Page 3 Out of 3. End of Report.the state’s words, verbatim · CDSS document, May 27, 2026 · control 26-AS-20260501153220

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Jun 3, 2026

87411 Personnel Requirements -General (a) Facility personnel shall at all times be … competent to provide the services necessary to meet resident needs. … additional staff for the provision of adequate services. This requirement was not met as evidence by: Based on interviews conducted, staff S1 was unable to demonstrate how he/she would be able contact and communicate with emergency services during an emergency. ADM acknowledged S1, being the only staff member in the home, during NOC shift, and not being able to communicatethe state’s words, verbatim · CDSS document, May 27, 2026

Plan of correction: Licensee stated to she will submit a written plan of action on how she will ensure there is at least 1 staff member in the facility, who is able to communicate with emergency services during an emergency. Licensee stated she will submit the plan of action by POC due date June 3, 2026. (Continued) without the assistance of ADM, who doesn’t live in the home. This poses a potential health, safety and personal rights risk to residents in care.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Lilly Li. During the visit, LPA observed 6 residents and 2 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 2 restrooms and 6 residents bedrooms. There was no obstruction to block the walkways. The staff area of the facility was also inspected. The front yard and backyard were inspected. 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 76 degrees F, and hot water temperature was measured at 119 degrees F in resident bathrooms. Fire extinguisher was serviced in October 1, 2025. 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 August 2, 2025. ADM stated she conducted additional drills but cannot find the documentation at this time. LPA reviewed facility records for 3 staff and 3 residents. LPA requested to review resident R2 and R3's Appraisal needs and Services Plan. LPA was not provided Appraisal Needs and services plan to review. LPA requested to review resident R2 and R3's doctors order for both residents half bed rails. LPA was not provided a copy of the doctors order for half bed rails to review. LPA reviewed 3 resident medications and centrally stored medication records. Deficiency and technical violation cited during today's visit. This report was reviewed with Administrator Lilly Li and a copy of the signed report was provided.the state’s words, verbatim · CDSS document, May 7, 2026

Type of visit: Prelicensing

Licensing Program Analysts (LPA) Marcela Yanez conducted a unannounced pre-licensing inspection for a change of ownership. The LPA met with Applicant, Lilly LI. The home currently has 6 residents. The facility fire clearance is approved for six (6) non ambulatory and hospice waiver for two (2). On 06/19/25 LPA visited facility to do a Pre-licensing inspection and Pre-Licensing was not completed. On 07/14/25 LPA toured the facility inside and out. The facility is equipped with smoke and carbon monoxide detectors in working condition. Fire extinguisher observed in the home which were all serviced on 10/10/24. The kitchen, dining and living room were observed in good repair. Resident bedrooms were observed in good repair, furnished, with clean linens and adequate lighting. Bathrooms were observed clean and equipped with grab bars. The water temperature range for facility bathrooms were 110.3 to 110.8 degrees F. The water temperature in the kitchen was measured at 108.5 degrees F. Centrally stored medication cabinet with first aid kit was observed locked. 2-day perishable and 7-day non-perishable food were observed in the kitchen. All outdoor and indoor passageways were observed clear and free of obstruction. The backyard was inspected, no bodies of water observed. LPAs observed garage and designated laundry area. LPA observed a locked shed used as storage and not living quarters. Page 1 of 2 Page 2 of 2 Component III orientation was completed with applicant. No issues noted during this pre-licensing inspection. LPAs observed the facility is ready to be licensed. However, this report will be submitted to the Central Application Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required. This report was reviewed with Applicant, Lilly Li and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 14, 2025

Type of visit: Prelicensing

Licensing Program Analysts (LPA) Marcela Yanez conducted a unannounced pre-licensing inspection for a change of ownership. LPA met with Applicant, Lily Li. The home currently has 5 residents. The facility is approved for Fire Clearance for 6 Non-Ambulatory residents. The facility room temperature was 75 degrees F. LPAs toured the facility inside and out. The facility is equipped with smoke and carbon monoxide detectors in working condition. Fire extinguisher observed in the home which was purchased on 10/10/24. The kitchen, dining and living room were observed in good repair. Resident bedrooms were observed in good repair, furnished, with clean linens and adequate lighting. Bathrooms were observed clean and equipped with grab bars. The water temperature range for facility bathrooms were 115 to 118 degrees F. The water temperature in the kitchen was measured at 113 degrees F. Centrally stored medication cabinet with first aid kit was observed locked. 2-day perishable and 7-day non-perishable food were observed in the kitchen. All outdoor and indoor passageways were observed clear and free of obstruction. The backyard was inspected, no bodies of water observed. LPAs observed garage and it is not being used as living quarters. LPA observed a shed being used as storage and not living quarters. Page 1 of 2 Page 2 of 2 Pre-Licensing is incomplete until current licensee clears deficiency for R1 who has a doctors order on file for full length bed rails without an approved exception by the department. A follow up Pre-licensure LIC809 will be generated upon resolution of deficiency No deficiencies were cited today per California Code of Regulations Title 22. An exit interview was conducted with Lily Li, Applicant , and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 19, 2025