Rainbow Cottage

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Ruth Martinez and Taylor Simerly arrived unannounced for the purpose of conducting the Required 1-Year annual evaluation. LPA was greeted and granted entry by the caregiver and explained the reason for the visit. Administrator Hanh Pham holds a valid certificate expiring on October 30, 2027. The facility is a single story structure licensed to provide services for age range 60 and over for six non-ambulatory. A waiver was granted to provide hospice services to four residents at one time. There currently are six residents of which one resident is currently receiving hospice care services. LPAs began the tour of the inside and outside of the facility. LPAs observed required department postings throughout the facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food storage in a two spare refrigerator in the garage. The facility is maintained at a comfortable temperature. LPAs inspected that medication is centrally stored in a safe locked storage cabinet located in the kitchen in front of the pantry. LPAs reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPAs observed the first aid kit. LPAs inspected the facility bathrooms and LPAs measured the hot water temperature which measured 112.4 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Lighting is sufficient to ensure safety and comfort. The facility is equipped with sufficient hand Continued on LIC809-C hygiene, cleaning, and disinfecting supplies. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored locked underneath kitchen sink. The facility has an available clean supply of linens. LPAs inspected residents’ bedrooms which have sufficient lighting to ensure safety and comfort. All bedrooms observed to have all required components. Storage space is provided for residents in their bedroom. Smoke detectors/carbon monoxide detectors were tested and found to be operational. LPA toured the outside of the facility and observed outdoor passageways are free of obstructions. LPAs observed there is an enclosed patio that provides shading for the residents. LPA observed a fire extinguisher with service date of August 25, 2025, charged and mounted in the kitchen. Fire drills are conducted every three months. LPAs began the review of records. LPAs reviewed six resident records. All the required documentation was present and reviewed in the residents’ files. LPA reviewed three employee records. All employees present have a criminal record clearance and are associated to the facility. LPA observed records reviewed have a current First Aid certificate. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the facility representative, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jun 25, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of conducting the Required 1-Year annual evaluation using the Care Inspection Tool. LPA was greeted and granted entry by Caregiver Imelda Navarro and explained the reason for the visit. Licensee/Administrator (Admin) Hanh Pham arrived on site to assist with the visit. Admin holds a valid certificate expiring on October 30, 2025. The facility is a single story structure is licensed to provide services for age range 60 and over for six non-ambulatory. A waiver was granted to provide hospice services to four residents at one time. During today's visit, there are no residents under hospice care and two staff providing care to five residents. LPA toured the physical plant with Caregiver Ma Alojado. Facility is clean and operational. LPA observed five resident bedrooms and three resident bathrooms. There is one additional staff bedroom occupied by two live in staff. Resident bedrooms had all required furnishings. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 115.3, 108.3, and 112.4 degrees Fahrenheit in the resident bathrooms. All common areas were inspected including the attached two car garage. LPA reviewed the Emergency Disaster Plan (LIC610E) last updated on March 13, 2022 and observed sufficient emergency food and water in the garage and kitchen pantry, however not all disaster supplies were obtained as noted on the LIC610E. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food available in the kitchen and garage. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. The exit gate is self-closing and self-latching. LPA observed sufficient seating and shading. The fire extinguisher was mounted and serviced on August 15, 2024. The auditory devices and smoke/carbon monoxide detectors were tested and operational. Emergency evacuation drills are conducted quarterly, however records are not maintained. Last drill started in December 2024 per Admin. The Complaint Poster, 'See Something, Say Something,' (PUB 475) was available and posted in the correct size. LPA conducted a review of all residents and two staff files. No discrepancies noted. Medications were audited in two out out of five residents. No discrepancies noted. Interviews were conducted with residents. No staff interviews conducted as both staff were assisting residents. The following items were addressed with the Admin: to submit a copy of the amended LIC610E and to obtain disaster supplies noted on the LIC610E, to maintain a log for the drills conducted, and to annually review the plan and to update as necessary. Based on the observations made during today's visit, no deficiencies are being cited. Advisory Notes (LIC9102s) are being issued. An exit interview was conducted with Licensee/Administrator Hanh Pham, and a copy of this report including the LIC809C, and LIC9102s were provided at the end of the visit.the state’s words, verbatim · CDSS document, May 20, 2025

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: POC

Licensing Program Analyst (LPA) Jessica Cho continued the visit after the annual inspection conducted on today's date to follow up on the deficiencies issued during the annual inspection conducted on June 17, 2024 from 1:50pm-5:00pm. LPA met with Licensee/Administrator Hanh Pham and explained the purpose of the visit. Regarding, 87608(a)(3), Postural Supports, regulation indicates that "a written order from a physician indicating the need for the postural support shall be maintained in the resident’s record." Orders were received by the Plan of Correction (POC) due date. Regarding, 87458(a) & (b)(1), Medical Assessment, indicates medical assessment is made within the last year and also the Tuberculosis (TB) test results are obtained. Medical assessments (LIC602s) and TB test results were provided by the POC due date. Facility has complied with the terms of the POC. An exit interview was conducted with Licensee/Administrator Hanh Pham, and a copy of this report including the the Letter of Deficiency Citations Cleared were provided at the end of the visit.the state’s words, verbatim · CDSS document, May 20, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) continued the visit on today's date after completing the annual inspection and Plan of Correction visits. The purpose of this visit is to follow up on a death report received by the Department dated September 5, 2024. Resident #1 (R1) passed away on August 21, 2024 and the time of death is unknown. It was noted that R1 passed in their sleep and was discovered not breathing at 7:15am. During today's visit, LPA interviewed one staff and obtained R1's face sheet, Physician's Report, Placement Appraisal Information. No deficiency is cited during today's visit. An exit interview was conducted with Licensee/Administrator Hanh Pham, and a copy of this report including the LIC811 were provided at exit.the state’s words, verbatim · CDSS document, May 20, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1 Year Inspection using the Care Inspection Tool. LPA Cho was greeted and granted entry by Caregiver Ma Alojado and stated the purpose of the visit. The facility is a single story structure located in a residential neighborhood. Facility is licensed to operate for six (6) non-ambulatory and maintains a hospice waiver of four (4). There is one (1) resident under hospice care on today's visit. LPA toured the interior and exterior portions of the facility. There are a total of five resident bedrooms and three resident bathrooms. There is also one staff bedroom and a private staff sun room. There is an additional sun room for the residents. LPA observed the facility to be clean and sanitary. The resident rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke/carbon monoxide detectors and auditory exit alarms were tested and operational. LPA observed bathrooms to be in good repair, provided with handrails, and a non-skid floor mat. The hot water measured at 116.4, 119.1, and 118.9 degrees Fahrenheit in the resident bathrooms. Facility met the two day perishable and seven day non-perishable food supply. LPA observed medications, toxins, and sharps were inaccessible to the residents. The fire extinguisher was serviced on 08/08/23. For the exterior portion, facility had sufficient seating and shading. The exit door was self-closing and self-latching. LPA observed the emergency disaster supplies including food/water. LPA observed the required "See Something, Say Something' (PUB475) posters in the required size. LPA conducted an audit of six residents' files and two staff files. Discrepancies noted. Staff interviews were conducted. Resident interviews were not conducted due to residents were busy at the time of the interview. Medications were audited for four residents. No discrepancies noted. LPA consulted the following: to obtain a doctor's order for the half rail beds for four (4) residents as well as a physician's reports for five (5) residents, obtain a Tuberculosis Test (TB) for two residents, and to pay the annual licensing fee that was due on June 14, 2024. Based on the observations made during today's visit, deficiencies are being cited as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. An exit interview was conducted with Caregivers Imelda Navarro, and Ma Alojado, and a copy of this report including the LIC809C, LIC809Ds, LIC811, and the appeal rights were provided during this visit.the state’s words, verbatim · CDSS document, Jun 17, 2024