Mary's Loving Care B

Type of visit: Required - 1 Year

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for six non-ambulatory residents. Facility has an approved hospice waiver for three residents and the home currently has no residents in care. House Manager (HM) Mary You assisted with visit. LPA along with staff toured the facility at 1:40 PM. LPA toured the physical plant and checked facility documentation. The home consists of four resident bedrooms, living room, dining room, kitchen, three bathrooms and an attached garage. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate residents comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured 107.4 F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. Kitchen appliances were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Outside grounds were toured. Walkways around the home were clear of hazards. There is shaded outdoor seating for residents. LPA observed the emergency food and water supply. LPA observed the first aid kit. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided along with appeal rights.the state’s words, verbatim · CDSS document, Mar 24, 2026

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Fred Arias made an unannounced visit for the purpose of conducting a case management visit. LPA was greeted and granted entry by staff and discussed the purpose of the inspection. During the visit, LPA toured the facility with staff. LPA observed one resident sitting in the living room and another resident in their bedroom watching TV. LPA observed perishable food in the refrigerator. LPA observed staff attending to residents. LPA observed the auditory exit alarms to be operational. LPA toured the exterior of the facility. Outdoor area was clear of hazards. Exit gate is unlocked and operational. LPA observed no health or safety issues during the inspection. Based on the observations made during today’s visit, no deficiencies are being cited at this time. This report was discussed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Nov 18, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Fred Arias made an unannounced visit for the purpose of conducting a Plan of Corrections Inspection for deficiencies issued on September 18, 2025 during a case management visit. LPA was greeted and granted entry by staff and discussed the purpose of the inspection. LPA toured the facility with staff and observed the refrigerator and exit doors accessible. Administrator Emma Han emailed LPA on September 19, 2025 in-service training conducted to correct the deficiencies and updated LIC500 showing updated coverage to provide R1 with one on one supervision and supervision policy. LPA observed R1 with a caregiver and a home health representative. The Plan of Corrections has been fulfilled by the assigned POC due date of September 19, 2025, thus clearing the Type A deficiencies CCR 87468.1(a)(3), 87468.1(a)(6), and 87411(a). This report was discussed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Sep 25, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Fred Arias made an unannounced visit for the purpose of conducting a Plan of Corrections Inspection for a deficiency issued on March 6, 2025 during the required annual inspection. LPA was greeted and granted entry by staff and discussed the purpose of the inspection. Administrator Emma Han provided training logs for four out of four staff. The Plan of Corrections has been fulfilled by the assigned POC due date of March 27, 2025, thus clearing the Type B deficiency HSC 1569.625(b)(2). During the POC visit, LPA toured the facility with staff. LPA observed the refrigerator in the kitchen locked using a bike lock. Staff stated resident 1 (R1) has dementia and opens the refrigerator door often and eats from there. LPA toured the exterior of the facility. LPA observed wood planks blocking three exit doors in the rear of the facility, preventing the doors from opening from the inside. LPA observed a double cylinder deadbolt installed on the front door, preventing exiting through the door unless a key is used to open the door. Three out of three staff stated the measures were taken due to R1's wandering behaviors. LPA captured images. LPA interviews with two out of three staff stated R1 has eloped the facility twice in the past. LIC500 personnel report shows one staff one duty per shift. Based on the observations made during today’s visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An immediate civil penalty for $500 is being assessed. See LIC421IM. This report was discussed with the facility representative and a copy was provided along with appeal rights.the state’s words, verbatim · CDSS document, Sep 18, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Sep 19, 2025

Personal Rights of Resident in All Facilities 87468.1(a)(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as ...interfering with daily living functions such as eating, sleeping, or elimination This requirement is not met as evidenced by: Facility is locking refrigerator preventing access to residents which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Sep 18, 2025

Plan of correction: AD stated staff will receive in-service training for keeping the refrigerator unlocked. AD to provide proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87468.1(a)(6) · Plan of correction due date: Sep 19, 2025

Personal Rights of Residents in All Facilities 87468.1(a)(3) To leave... the facility at any time and to not be locked into any...building, or on facility premises by day or night. This requirement is not met as evidenced by: Facility is blocking exit doors from the outside and locking the front door with a key preventing residents from leaving which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Sep 18, 2025

Plan of correction: Facility removed wood planks from the exit doors and unlocked front door. AD stated staff will receive in-service training for keep exits unlocked and clear. AD to provide proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Sep 19, 2025

87411(a) Personnel Requirements - General Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Based on LPA observations and interviews, R1 has eloped twice in the past which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Sep 18, 2025

Plan of correction: AD stated a second staff member from the adjacent facility will monitor R1 when other staff member is attending to other resident. AD will provide LPA with an updated LIC500 and a policy dictating procedure.

Type of visit: POC

Licensing Program Analyst (LPA) Fred Arias made an unannounced visit for the purpose of conducting a Plan of Corrections Inspection for a deficiency issued on 03/06/2025 during the required annual inspection. LPA was greeted and granted entry by staff. LPA discussed the purpose of the inspection with AD Han. LPA toured the facility to check the deficiency has been corrected with AD. AD explained she has not purchased emergency food but will take care of it soon. Based on LPA's observation on today's visit, a deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Administrator Emma Han and a copy of this report was provided to the facility representative along with appeal rights.the state’s words, verbatim · CDSS document, Apr 23, 2025

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.695(a)(2) · Plan of correction due date: Apr 30, 2025

(a)In addition to any other requirement of this chapter... (2) Plans for the facility to be self-reliant for a period of not less than 72 hours immediately following any emergency or disaster... This requirement is not met as evidenced by: Based on LPA observation, the facility does not have emergency food to be self reliant for at least 72 hours which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Apr 23, 2025

Plan of correction: AD purchased 2 emergency food buckets online today. AD to email LPA pictures of food buckets and purchase receipt.

Type of visit: POC

Licensing Program Analyst (LPA) Fred Arias made an unannounced visit for the purpose of conducting a Plan of Corrections Inspection for deficiencies issued on 03/06/2025 during the required annual inspection. LPA was greeted and granted entry by staff Marc Zalameda. LPA discussed the purpose of the inspection with staff Zalameda. LPA toured the facility to check the deficiencies have been corrected. One camera was removed from a resident's room and one camera was removed from the kitchen. A third camera remains in place in the kitchen but has been disconnected until a commercial no audio camera can be installed. LPA observed there were no medications in the kitchen cabinets. Based on LPA observation on today's visit, the Plan of Corrections has been fulfilled by the assigned POC due date of 03/11/2025, thus clearing the Type B deficiencies CCR 87468.2(a)(1) and 87265(h)(2). An exit interview was conducted with staff Marc Zalameda and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 11, 2025

Type of visit: Required - 1 Year

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 3 residents and the home currently has 3 residents. Administrator (AD) Xu Han arrived later to assist with the visit. AD Han has a valid certificate that expires on 10/15/2026. AD provided updated liability insurance that expires on 7/24/2025. LPA along with staff Marc toured the facility at 9:00 AM. LPA toured the physical plant, checked food service, facility documentation and the first aid kit. The home consists of 4 resident bedrooms, living room, dining room, staff room, and kitchen as well as 4 bathtrooms. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 116.2 degrees F and 118 degrees F in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. LPA toured the kitchen and observed sharps locked in a cabinet during today's visit. At 9:07am, LPA observed a bottle of laxative and medications in a plastic cup in an unlocked kitchen cabinet. At 9:10am, LPA observed 2 cameras with audio above the kitchen facing the living room. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. At 9:16AM, LPA observed a camera with audio in R2's bedroom. Smoke detectors tested operational during today's visit. Fire extinguisher was fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts quarterly emergency drills with the last drill conducted on 11/18/2024. LPAs reviewed three resident files and two staff files. Continued on LIC809C dated 3/6/2025 Outside grounds were toured. There are no security bars or weapons on the premises. There is shaded outdoor seating for residents. Exit gate is unlocked and operational. LPA observed there is no emergency food or water supply. First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of cognitive exercise, physical exercise, and walks. All resident files contained required documentation including admission agreements, physician reports, resident appraisals. Staff files reviewed contained required documentation except for the required annual training. The last annual training were conducted in 2023. LPA reviewed medication storage and administration. Medications are stored in a locked closet. Medications are being administered per physician order. Based on the observations made during today’s visit, the following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Mar 6, 2025

The state marks this report as 7 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.