Superior Residential Care Facility for the Elderly

Type of visit: Required - 1 Year

At 8:15am on 03/05/2026, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct the annual, facility inspection. LPA met with Licensee Eric So Hu, and announced who he was and the reason for the visit. Licensee and LPA reviewed facility clearance roster and confirmed all staff working were on the facility roster and all cleared. Licensee and LPA conducted a cursory tour of the facility. This facility is a seven bedroom, 4 bathroom with kitchen, two living rooms and dining room. The 7th bedroom is for live-in staff in the center of the facility. LPA observed that all bath rooms were stocked with liquid soap and paper towels. LPA observed at least a 30 day supply of incontinence supplies and more than 30 day supply of PPE located in the garage. LPA observed each resident room and all rooms are in compliance with regulation standards with appropriate bedding, lighting, drawers and storage. LPA noted that each room had its own exit and all exits were free and clear of obstructions and hazards. LPA noted that each room and hallway had smoke detectors and were functioning properly, additionally there is a carbon monoxide detector located in the hallway that was tested and functioning properly. LPA observed a fire extinguisher that was charged in the green. LPA observed at least 2 days of perishable and at least 7 days of non-perishable foods. LPA tested facility water temperature and noted that it was within regulation parameters of 105*-120(f). LAP noted that bathroom #2 requires repair to the bathtub drain and dry wall behind the commode, a citation was issued (87303(a)). LPA conducted file reviews of staff and resident files, centrally stored medication records (CSMR) Medication Administrator Records (CSMR) and conducted a sample medication audit. LPA reviewed Liability Insurance, Emergency Disaster Plan and Infection Control Plan. All documentation and audit presented no regulation issues. Licensee and LPA conducted a full review of the annual care tools. There was one citation as a result of this annual inspection. No other violations or citations were noted during the full annual inspection. . Exit interview, report singed, appeal rights and report provided.the state’s words, verbatim · CDSS document, Mar 5, 2026

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Annual Continuation

At 01:05pm on 03/25/2025, Licensing Program Analysts (LPA)s Haner-Tomasko and Jeffries arrived unannounced to the facility to conduct a continuation of the annual inspection started on 03/13/2025. LPAs met with Administrator Laarni So Hu and announced the purpose of the visit. LPA observed a new fire extinguisher purchased 03/14/2025. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records, finding no violations. LPA toured the kitchen area and garage to review previously cited deficiencies to find the garage door, all medications, and sharps locked appropriately. LPA noted 4 staff conducted CPR and 1st aid training on 3/13/2025. LPA and Administrator completed review of the annual care tool modules. Exit interview, report signed, and report provided.the state’s words, verbatim · CDSS document, Mar 25, 2025

Type of visit: Required - 1 Year

At 10:30am on 03/13/2025, Licensing Program Analysts (LPA)s Garrett Haner-Tomasko and Melisa Rankin arrived unannounced to the facility to conduct the annual inspection. LPA met with Administrator Laarni So Hu and announced the purpose of the visit. Licensee and LPAs reviewed facility clearance roster and confirmed all staff working were on the facility roster and all cleared. Licensee and LPAs conducted a cursory tour of the facility. This facility is a seven-bedroom, 4 bathroom home with kitchen, two living rooms and dining room. There is a large center courtyard with a pergola that provided shade for residents. Five of the bedrooms are single occupancy resident rooms, the other bedrooms are for live-in staff. LPA observed that all bath rooms were stocked with liquid soap and paper towels. LPA observed each resident room and all rooms are in compliance with regulation standards with appropriate bedding, lighting, and storage. LPA noted that each room had its own exit, and all exits were free and clear of obstructions and hazards. LPA noted that smoke detectors and carbon monoxide detectors were functioning at the time of visit. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid mats/flooring. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. The facility has a fenced backyard for client use with plenty of shade. The facility has telephone and internet service for resident use. LPA observed and cited for fire extinguisher due to it being purchased in 2023 and not tested since. LPA observed at least 2 days of perishable and at least seven days of non-perishable foods. LPA tested facility water temperature and noted that it was within regulation parameters of 105*-120P(f). (Continued LIC809-C) During LPAs tour of the kitchen area medication was found on the kitchen counter, narcotics were discovered unlocked in the refrigerator, unlocked cabinets containing scissors were observed. While touring the garage, LPAs found that the door was unlocked, and the garage contained chemicals and knives which were accessible to residents in care. LPAs observed staff entering and exciting garage door various times and when asked they stated they locked the door at night, but during the day staff are monitoring. All items noted above were cited. While reviewing facility records, staff have annual training completed for all subjects/topics and hours for 2024. It was noted that CPR and 1st Aid training certificates were not valid and needed updating, this is a safety concern for residents in care, facility was cited. LPAs conducted interviews with all 4 residents in care. Residents all noted that they feel safe and supported in the facility, they have no concerns or complaints. LPA observed 3 out of the 4 residents with visitors, all visitors were allowed to enter and communicated efficiently and with ease with administrator. Exit interview done, annual report, citations, and appeal rights were printed and provided to administrator. Further time is needed, annual will be completed at a laterthe state’s words, verbatim · CDSS document, Mar 13, 2025

The state marks this report as 11 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 03/14/2024, Licensing Program Analyst (LPA) Brian Phillips arrived unannounced for an unscheduled visit to conduct a required Annual site inspection visit at the facility above. When the LPA arrived, they were greeted by Administrator Laarni So Hu, and informed them of the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. This is a Residential Care Facility for the Elderly (RCFE), with an approved fire clearance capacity of Six (6) residents. The facility is approved for 6 non-ambulatory residents, with an age range of residents sixty (60) years of age and older. The facility has an approved Hospice Waiver for three (3) residents. The physical plant of the facility consists of seven (7) bedrooms, four (4) restrooms with kitchen, two living rooms and a dining room. There is a large center courtyard with a covered gazebo/patio that provided shade for residents. Six (6) of the bedrooms are single occupancy resident rooms, the other bedroom is for live-in staff. Three (3) bathrooms are double entry bathrooms that are attached to two (2) resident rooms each. The facility contains an outside area for residents to utilize for outdoor activities/outdoor visitations and an outdoor patio area with furniture and shade. KITCHEN: The facility maintains a kitchen room/area within the interior of the facilty. The LPA inspected the kitchen/food service area and observed that knives/sharp instruments are stored in a locked drawer inaccessible to residents. Kitchen appliances were in operable condition and looked clean/in good repair. The LPA observed perishable items in good condition, with proper expiration dates precluding the perishable items from expiring. The facility has a sufficient supply of perishable and non-perishable food, which would last over a week (7 days). Additional perishable food items were maintained in a storage area in a locked cabinet in the kitchen area of the facility as well as an extra refrigerator and extra freezer located in a locked room/addendum off of the hallway of the facility. The hot water temperature was measured in the kitchen at an appropriate temperature as per the regulation between 105-120 degrees Fahrenheit. Items that could constitute a danger to residents are kept inaccessible to residents in the kitchen area. Contd. 809-C The kitchen was clean and sanitary, with covered trashcans and operating ventilation systems. No toxic substances are stored in any food preparation or storage area, and all cleaning supplies for the kitchen are kept in a separate area than the food supplies. The freezer and refrigerator were both the appropriate temperate Fahrenheit for the storage of food and prevention of spoiling. There is enough tableware and utensils for all residents living in the facility, and enough equipment for the storage, preparation, and service of food. COMMON AREAS: The indoor areas of the facility consist of seven (7) bedrooms, four (4) restrooms with kitchen, two living rooms and a dining room. There is a large center courtyard with a covered gazebo/patio that provided shade for residents. Six (6) of the bedrooms are single occupancy resident rooms, the other bedroom is for live-in staff. Three (3) bathrooms are double entry bathrooms that are attached to two (2) resident rooms each. At the time of the visit, the common areas of the facility were observed to be appropriately furnished, with all furniture in good condition. There are no fireplaces in the facility, therefore no need to be inaccessible to residents. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector(s) were operational at the time of the visit. The facility has multiple fire extinguishers that were fully charged and serviced annually. This facility contains a main hallway, Television room, family room, open patio, locked centrally stored medication containment area, extra storage areas for additional perishable food, closets/rooms in the hallways of the facility containing extra linen/bedsheets/pillows, and storage areas for resident personal hygiene equipment constituting the interior areas of the facility. The LPA observed required postings throughout the common spaces including Resident Personal Rights and Contact information for Ombudsman as well as Licensing. There are activity supplies and equipment, including activity materials for the residents such as television, puzzles, games, etc. All window screens were in good repair. There is appropriate lighting in the common areas of the facility. All passageways through the common areas of the facility were free of obstruction, and all inclines are well-lit with no stairwells/stairs for resident use. The kitchen, living room, and dining area are neat and clean. The facility maintains a comfortable temperature. Hallways, bedroom doors, and walls are in good repair. OUTSIDE/LAUNDRY/MISCELLANEOUS: The front outdoor area of the facility is well maintained and consists of cement walkways and grass areas. There is an empty fountain in the front yard of the facility which contains no body of water. The facility outdoor areas are maintained with no observable hazards to residents in care. The backyard/patio room is conducive for outdoor visitation. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. The exterior of the facility has a closed perimeter which consists of a wall around the entire facility with latched gates. Continued on 809-C Inside of the perimeter is the outdoor/outside activity area for residents with a patio in the backyard, furniture, shade, and a shed that contains outdoor maintenance materials for the facility. LPA was shown the inside of the shed upon request. The facility has an outdoor activity area that is provided with a shaded area and furnished for outdoor use. There are no bodies of water noted on the facility property. The designated laundry area is a Staff only locked room/garage of the facility, and there is another locked storage area where cleaning products are stored, which are kept locked and inaccessible to residents. Staff members are the only individuals allowed to do laundry and the entire room is kept locked at all times. There was emergency food and water in a storage area in the back of the facility and in the extra perishable food storage area which was observed to be in good condition. Cleaning supplies, disinfectants, and other items that could pose a danger to residents are kept in areas inaccessible to residents. There is a first aid kit that includes sterile dressings, bandages, thermometers, scissors, tweezers, and a first aid manual. The vehicles used to transport residents are in safe operating condition with appropriate insurance information. LPA did not observe any noticeable outdoor hazards in areas accessible to residents. There is a main entrance walkway into the facility and an administrative entrance area for visitors. BEDROOMS: The facility has the facility consists of seven (7) bedrooms, with Six (6) of the bedrooms being single occupancy resident rooms, the other bedroom is for live-in staff. The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. The bedrooms have storage areas for clean linens, towels, pillows, etc. Each resident’s bedroom has a single bed or beds, nightstand, and lights/nightstand lamps to provide sufficient lighting. Each closet in all the resident rooms has extra pillows, clean/fresh linens, and appropriate incontinence materials if applicable for any resident. The resident bedrooms are big enough for all the beds, furniture, and any resident assistive device a resident might need such as a wheelchair or a walker. Each room has sufficient lighting for each resident. All resident bedrooms in the facility contain sliding doors to the exterior of the facility, monitored by the auditory system in place by the facility that alerts Staff when a door exiting the facility has been opened. RESTROOMS: There are four (4) resident restrooms, with three (3) restrooms are double entry bathrooms that are attached to two (2) resident rooms each. The facility restrooms were sanitized and in operating condition while the LPA toured the facility. All restrooms/showers inspected had assistive equipment for residents including grab bars and/or non-skid surfaces. The restrooms were sufficiently stocked with soap, paper towels, and additional supplies; towels and washcloths are not shared. Continued on 809-C The hot water temperature was measured in the restrooms at the appropriate degrees Fahrenheit as per the regulations between 105-120 degrees Fahrenheit. Nightlights are installed in the hallways outside of the resident restrooms. All resident restrooms consist of a sink and toilet, while the resident shower/bathing areas consist of a shower and/or bathing area with grab bars and non-skid surfaces. RECORDS: The facility keeps confidential storage of both resident and Staff member records on-site at the facility. Staff member records were reviewed for, but not limited to Health Screening Report/Tuberculosis (TB) Clearance for facility personnel, Personnel Record (employment application), verification of age over 18 years old, education, and experience, approved Certification for the Administrator, verification of first aid training, Criminal Record Statement, Criminal Record Clearance/Exemption, Verification of Staff training, Employee Rights, and Abuse Reporting Requirements. All staff members’ personnel records reviewed by LPA had the appropriate documentation. The administrator of the facility has an active Residential Care Facility for the Elderly (RCFE) Administrator Certificate. Resident records were reviewed for, but not limited to Pre-Admission/Placement appraisals, Resident Appraisals, Appraisal Needs and Services Plan (ANS), Physicians’ Report for RCFE, Identification and Emergency Information, Current Admission Agreement with signatures, Personal Rights for Residents, Record of Residents safeguarded cash resources, Record of Resident personal property/valuables, Physician Orders for Life Sustaining Treatment (POLST), Responsible Person or Conservator of Resident, Self-management of medications if applicable, Medication Orders, and Medication Logs. The facility also keeps records of resident vital signs and a resident weight record for all resident files reviewed. All resident records reviewed by the LPA had the appropriate documentation with no missing or incomplete information. MEDICATIONS: The facility maintains a locked centralized storage area for resident medications. Centrally Stored Medications are in a locked storage containment area within a cabinet in the garage of the facility, which is located in the Main building of the facility. The medication cabinet remains locked at all times, inaccessible/locked to residents. The garage area of the facility is a Staff only area, and inaccessible to residents of the facility. The LPA observed the centrally stored medications as well as the Centrally Stored Medication and Destruction Record, The Medication Administration Record, and the record of Controlled Medications. LPA audited the medications for residents and noticed no irregularities or issues concerning the dispensing of medications or the logging of medications. The medications in the facility were labeled appropriately with no additional or prohibited markings by the facility. Continued on 809-C INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening and a sanitation station. The staff members will keep up signs that promote good hand hygiene and symptoms of COVID. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. FACILITY DOCUMENTATION: There are required postings throughout the facility, including emergency exit plans with necessary telephone numbers. The facility keeps posted copies of facility documentation such as the RCFE License Certificate, LIC 500 Personnel Report, Documentation of Facility Waivers, Plan of Operation, Emergency Disaster Plan for Residential Care Facilities for the Elderly (RCFE), Facility Infection Control Plan/Mitigation Plan, Certificate of Liability Insurance, Valid Administrator Certificate, and a Facility Sketch. Provider Information Notices are available and able to be presented to Staff, residents, visitors, and accessible to LPA upon request during the inspection process. No deficiencies cited. Exit interview conducted. A copy of the report was issued to the facility.the state’s words, verbatim · CDSS document, Mar 14, 2024