Rn Loving Care Home I

Type of visit: Required - 1 Year

On 04/23/2026 at 01:45 PM, Licensing Program Analyst (LPA) David Doidge arrived to conduct 1-Year Annual Required inspection. LPA met with Administrators Jianyin Lou Yue Hui Mou and explained the purpose of the visit. During the visit, LPA toured facility including but not limited to the kitchen, dining room, resident bedrooms and bathrooms, front and back area of the facility, and common areas. Fire extinguisher last inspected on 04/23/2026. Smoke detectors and carbon monoxide detectors were tested and observed to be functional. LPA observed the facility to be at a comfortable 74 degrees Fahrenheit. All indoor and outdoor passageways are kept free of obstruction. Hot water temperature was measured at 120 degrees Fahrenheit. LPA observed skid mats and grab bars in resident bathrooms. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present in or around the facility. LPA observed a sufficient supply of 7 day non-perishables and two day perishable food supplies. LPA reviewed five (5) resident files and three (3) staff files. Emergency Disaster drills are conducted quarterly; last drill was conducted on 01/15/2026 Centrally stored medications were observed locked in a cabinet. No deficiencies were cited during this inspection. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 23, 2026

Allegation investigated: Staff did not ensure the facility’s telephone was not in disrepair

On 08/08/25 at 09:00 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a 10-day complaint visit and deliver the findings. LPA was greeted by S3, explained the purpose of the visit, and Yue Hui Mou, Administrator arrived about 15 minutes later. Allegation: SUBSTANTIATED Staff did not ensure the facility’s telephone was not in disrepair Upon receipt of the complaint on 08/06/25, LPA reviewed CCLD’s FAS system and dialed the facility’s telephone number on record and the facility’s mobile number on record. S1 answered the call and confirmed that the telephone number was in fact S1’s mobile number. LPA dialed the facility’s landline twice; at first it rang several times, no messaging service was available, and the call disconnected. LPA immediately called back, and the call was answered by S2 who confirmed that he/she was present at the facility. Continued on LIC9099C... Substantiated ...continued from LIC9099. On 08/08/25, LPA tested the landline with S3 while on site at the facility and confirmed the service is working; however, the phone did not ring, S3 was not able to hear the telephone ring in order to answer it. LPA advised S1 to review the following Title 22 regulations: 87468.1 - Personal Rights of Residents in All Facilities and 87311 - Telephones. Based on LPA’s interviews and records reviewed, the preponderance of evidence standard has been met; therefore, the above allegation is SUBSTANTIATED. Deficiency is cited from Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction by plan of correction due date, and any repeat violations within a 12-month period may result in civil penalties. Exit interview conducted, appeal rights and a copy of this report providedthe state’s words, verbatim · CDSS document, Aug 8, 2025 · control 15-AS-20250806163803

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87468.1(a)(14) · Plan of correction due date: Aug 15, 2025

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (14) To have reasonable access to telephones, to both make and receive confidential calls...-This requirement is not met as evidenced by: Licensee/ED did not ensure that the facility’s telephone was working properly so that residents could receive incoming calls.the state’s words, verbatim · CDSS document, Aug 8, 2025

Plan of correction: Licensee/ED to review regulations, provide in-service training for all staff along with signatures, and LPA confirmed phone rang as proof to CCLD by POC date.

Type of visit: Case Management - Other

On 08/08/25 at 10:30 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced and conducted a case management. LPA was greeted by S3, explained the purpose of the visit, and Yue Hui Mou, Administrator arrived about 15 minutes later. During the investigation for complaint 15-AS-20250806163803 dated 08/06/25, records revealed that S2 received criminal record clearance on 07/29/25 but had not been associated to the facility. LPA and CCLD's staff support provided guidance and instructions to S1 to complete the association for S2. Exit interview conducted, and a copy of this report provided to Yue Hui Mou, Administrator.the state’s words, verbatim · CDSS document, Aug 8, 2025

Type of visit: Required - 1 Year

On 03/14/25 at 08:45 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Yue Hui Mou and Jianyin lou Administrator (ADMs) and explained the purpose of the visit. LPA and ADMs the toured facility including, but not limited to bedrooms, bathrooms, kitchen, dining room, common area, front yard, and backyard. All outdoor and indoor passageways were free of obstruction. There were not any bodies of water observed. A comfortable temperature was maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms to be adequate for the comfort and safety of all the residents. The hot water temperature in the residents’ shared bathroom was last measured at 115 degrees Fahrenheit. Residents’ bathrooms were equipped with grab bars and non-skid mats. There was a minimum of one week supply of non-perishables and 2 days of perishable foods. Centrally stored medications and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition. Fire extinguisher was observed full. Emergency Disaster Plan was last posted on 04/10/24. First aid kit was observed to be complete. Safety drill was conducted last quarter. LPA reviewed six (6) residents records; Of four (4) staff records; three (3) staff were complete. Continued on LIC9099C... ...continued from LIC9099. The following forms are to be updated and submitted to CCLD 03/17/25: -Resident Roster -LIC500 Personnel Report -LIC308 Designation of Administrative Responsibility -LIC610 Emergency Disaster Plan (Reviewed) -An updated copy of Administrator Certificate(s) (Pending) -Liability Insurance (Reviewed, exp:11/2025) -Proof of CPR Exit interview conducted and a copy of this report provided to ADMs.the state’s words, verbatim · CDSS document, Mar 14, 2025

The state marks this report as 7 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 04/10/24 at 11AM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced required annual inspection. L PA met with Administrator (ADM) Yue 'Andy' Mou, and explained the purpose of the visit. ADM currently holds an administrator certificate (#6701195640) that expires on 08/30/25. The facility’s fire clearance was approved for six (6) non-ambulatory residents; all six (6) may be non-ambulatory and two (2) may be hospice. At 11:20AM, LPA and ADM toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, and outside yard area. The facility consists of six (6) bedrooms with adequate lighting for the comfort and safety of all residents. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizers were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Hot water temperature in the shared residents' bathrooms was measured at 115 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Inside and outside pathways were free of obstruction and fire hazards. Smoke and Carbon monoxide detectors were operational. Fire extinguishers were observed fully charged and last inspected on 02/19/24. LPA reviewed 4 staff and 5 client files during visit. No deficiencies observed during visit. Updated copies of the following documents were collected for facility file:  LIC500- Personnel Report  Residents Roster  LIC308- Designation of Facility Responsibility  LIC610E- Emergency/Disaster Plan including infection control plans  Evidence of Liability Insurance Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 10, 2024