Superior Residential Care for the Elderly II

Type of visit: Required - 1 Year

At 11:03am on 03/05/2026, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct the facility annual inspection. LPA met with Licensee Eric So Hu, and announced who he is 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 7 bedroom, 3 bathroom with kitchen, living and dining room. There is a large center patio with a awning that provided shade for residents and visitors. Five of the bedrooms are single occupancy resident rooms, the other bedroom is for live-in staff. 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 had working smoke detectors and were 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 and a 72 hours supply of water in the garage.. LPA tested facility water temperature and noted that it was within regulation parameters of 105*-120 (f). LAP did not observe any violations or citations during the cursory walk through tour of the facility. Licensee and LPA conducted the annual care tool modules of the annual inspection tool. LPA noted that no violations, or citations were discovered as a result of this annual inspection. LPA noted that no violations or citations issued during the review of the care tool modules. at this time there are no citations or violations as are result of the facilities. annual inspection at this time. Exit interview, report read, and report provided.the state’s words, verbatim · CDSS document, Mar 5, 2026

Type of visit: Required - 1 Year

At 8:25am on 04/07/2025, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct the facility annual inspection. LPA met with Licensee Eric So Hu, and announced who he is 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 six bedroom, 3 bathroom with kitchen, two living rooms and dining room. Licensee sill considering converting second living room into a single bedroom and will contact LPA when ready for new fire clearance. There is a large center patio with a awning that provided shade for residents and visitors. Five of the bedrooms are single occupancy resident rooms, the other bedroom is for live-in staff. 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 had working smoke detectors and were functioning properly.. LPA observed a fire extinguisher that was charged in the green. LPA observed at least 2 days of perishable and at least seven days of non-perishable foods and a 72 hours supply of water in the garage.. LPA tested facility water temperature and noted that it was within regulation parameters of 105*-120 (f). LAP did not observe any violations or citations during the cursory walk through tour of the facility. Licensee and LPA conducted the annual care tool modules of the annual inspection tool. LPA noted that no violations, or citations were discovered as a result of this annual inspection. LPA noted that no violations or citations issued during the review of the care tool modules. at this time there are no citations or violations as are result of the facilities., annual inspection at this time. Exit interview, report read, and report provided.the state’s words, verbatim · CDSS document, Apr 7, 2025

The state marks this report as 5 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 04/09/2024, 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 SoHu and Caregiver Rebecca Valencia, 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 Two (2) residents. The physical plant of the facility consists of five (5) bedrooms, three (3) restrooms, with kitchen, family room, dining room, garage, two (2) Staff member rooms, and backyard outdoor area. The backyard area has a gazebo that provided shade for residents with outdoor furniture. The restrooms are communal, with three of the restrooms attached to two 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 facility. 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). 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. The kitchen was clean and sanitary, with covered trashcans and operating ventilation systems. Continued on 809-C 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 5 bedrooms, 3 restrooms with kitchen, family room, dining room and 2 Staff rooms. 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 is a fireplace in the family room of the facility, which is 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 a fire extinguisher that was fully charged and serviced annually. This facility contains a 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. 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. Inside of the perimeter is the outdoor/outside activity area for residents with a patio in the backyard, furniture, and shade. 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. Continued on 809-C 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. The backyard of the facility has a grass area, barbeque, and a small shed which was observed and inspected by LPA. BEDROOMS: The facility consists of five (5) bedrooms, with the smaller of the two living rooms being converted into an additional bedroom for 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 three (3) resident restrooms, being 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. 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. Continued on 809-C MEDICATIONS: The facility maintains a locked centralized storage area for resident medications. Centrally Stored Medications are in a locked storage containment area in the facility. The medications remain locked at all times, inaccessible/locked to residents. 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. 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. LPA noted that no violations, technical assistance, or citations were issued during this annual inspection at this time. No deficiencies cited. Exit interview conducted. A copy of the report was issued to the facility.the state’s words, verbatim · CDSS document, Apr 9, 2024

Allegation investigated: Due to neglect, Resident sustained multiple bruises Staff are not providing food to resident Staff are not meeting resident's needs Staff could not provide emergency information to paramedics Facility is over ratio Staff did not provide adequate medication assistance Facility is unkempt

On 11/15/2023, Licensing Program Analyst (LPA) Brian Phillips conducted a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, LPA Brian Phillips met with Caregiver/Direct Support Staff Rebecca Valencia, as the Administrator was unavailable, and explained the reason for the visit. On 06/21/2023, the Department received a complaint regarding an allegation of Neglect/Lack of Supervision. It was alleged Resident #1 (R1) sustained unexplained bruises while in the care of the facility. The complaint was referred to the Community Care Licensing (CCL) Investigations Branch (IB) and assigned to Investigator Laarni Santiago. On 06/22/2023, from 7:46am to 9:57am, Licensing Program Analyst (LPA) Mark Jeffries arrived at the facility unannounced to conduct the initial complaint investigation. LPA Jeffries met with licensee/administrator Eric So Hu and explained the reason for the visit. Continued on 9099-C Unsubstantiated At 8:05am the administrator and LPA conducted a physical tour and health and welfare check of the facility and its residents. The LPA requested facility file documents pertinent to the investigation and noted further investigation was required prior to issuing findings. Investigator Santiago conducted interviews on 07/05/2023, at approximately 11:49am, with the reporting party; on 07/27/2023, from approximately 9:47am to 10:55am, with Staff #1 (S1) and residents; on 09/05/2023, at approximately 9:47am, with R1’s resident representative; on 09/11/2023, from approximately 1:15pm to 2:15pm, with R1, licensee, and administrator; and on 09/15/2023, at approximately 11:30am, with American Medical Response (AMR) paramedic. In addition, the investigator reviewed incident reports, Marian Regional Medical Center medical records, and facility file documents related to the investigation. LPA Brian Phillips conducted record review and interviews into the other allegations. According to R1’s physician report and preplacement appraisal information, R1 had diagnoses of depression, high blood pressure, and experienced lots of pain in arm and back. R1 had the capacity for all self-care. R1 was able to demonstrate the mental and physical ability to leave a building without the assistance of a person or the use of a mechanical device. R1 did not use a walker or wheelchair. R1 does not need help in transferring in and out of bed and dressing. R1 does not need help with moving about the facility. R1 did not require special observation/night supervision (due to confusion, forgetfulness or wandering). R1 can independently transfer to and from bed. A review of R1’s incident reports revealed that on 06/16/2023, at approximately 10:00am, R1 was noted to be progressively more confused and with hallucinations. R1 was seen by the primary care physician for confusion about two weeks prior and labs were ordered to rule out urinary tract infection (UTI). R1 reported falling out of bed early in the morning as they rolled out of their bed. The incident report noted R1 is independent with their activities of daily living (ADLs) and is ambulatory without assistance. R1 was admitted to the hospital for further testing and UTI. R1 was discharged from the hospital on 06/18/2023. On 06/20/2023, R1 was noted to have a small bump on head in the early morning, was offered to go to the emergency room (ER) but refused. On 06/21/2023, at approximately 07:25am, S1 was surprised that the fire department was at the front door looking for R1. R1 called 911 without notifying S1. R1 stated they called 911 because they felt sick and weak. According to the Marian Regional Medical Center medical records, R1 was seen in the ER on 06/21/2023 with the chief complaint of weakness. Continued on 9099-C The records noted “patient having general weakness for 4 days after a fall, seen recently and treated for UTI”. Bruising was noted on multiple areas of R1’s face that had not been documented from the recent admission on 06/16/2023 and assumed to be new. R1 was unable to recall what caused the bruising. X-rays were completed and did not reveal any fractures. R1 was admitted to the hospital 06/21/2023 and treated for Hypertensive urgency, UTI, and AKI. R1 was discharged 06/27/2023 to a Skilled Nursing Facility (SNF). During the investigation, interviews were conducted with the licensee, administrator, staff, residents, R1 and outside sources. Medical records were also obtained and reviewed. The records and interviews revealed that R1 was independent with the majority of activities of daily living (ADL's). Interviews indicated that R1 did not require close supervision and could independently navigate around the facility. R1 was alert, oriented and could communicate their needs. The staff, outside sources and R1 all corroborated that R1 did not require close supervision when navigating around the facility. Although R1 had a history of unwitnessed falls, they were during when R1 would roll off the edge of the bed. R1 was able to pick themself up and go back to bed and reported the incident to staff the following day. R1 declined to go to the hospital and did not request staff to initiate emergency medical services when they sustained bruises from the fall. R1 confirmed that R1 did not request medical services until they felt sick and weak on 06/21/2023. Furthermore, the interviews with residents denied any neglect by staff and indicated that their needs were met at the facility. Based on interviews and records review, there is insufficient evidence to prove the alleged violation occurred. Therefore, the allegation “Due to neglect, Resident sustained multiple bruises” is deemed Unsubstantiated at this time. On the allegation: Staff are not providing food to resident. The Reporting Party (RP) alleged that Resident #1 (R1) stated to RP that the Staff members are not feeding R1. Interviews were conducted with the Licensee/Administrator, Staff members, residents, and various witnesses. Medical records of R1 were obtained and reviewed. Through interview and record review it was revealed that R1 was independent with majority of Activities of Daily Living (ADLs). Interviews indicated R1 did not require close supervision and could independently navigate around the facility. R1 was also alert, oriented and could communicate their needs. Staff, witnesses/outside sources, and R1 all corroborated that R1 did not require close supervision when navigating around the facility. Continued on 9099-C According to the documented Preplacement Appraisal for R1, there were no services needed regarding a special diet or observation of food intake. The RCFE Physicians Report for R1 indicated that R1 has a capacity for self-care including being able to feed self. Based on the information obtained through interview and record review, there was insufficient evidence to prove the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. On the allegation: Staff are not meeting resident's needs. It was alleged by the Reporting Party (RP) that Resident #1 (R1) has been left in their urine and feces all night and no Staff came to assist R1. RP stated that R1 was not able to get to the bathroom by themselves due to being sick, but no Staff assisted R1. RP stated that R1 fell on 6/16/2023, trying to get to the bathroom because staff wouldn’t come help them. RP alleged that R1 stated they did not know the last time they had been showered and that R1 is allegedly left in their room all day. Interviews were conducted with the Licensee/Administrator, Staff members, residents, and various witnesses. Interviews with the residents of the facility indicated that their needs were being met at the facility by Staff members. All residents interviewed denied any unmet needs on the part of the Staff. R1 was interviewed and stated that Staff assisted them with cleaning, showers, laundry, and medication. All residents interviewed confirmed the staff assist them with ADLs as needed, and they do not have any unmet needs. Residents reported they were frequently checked on in their rooms and assisted with medications and laundry. Although R1 had a history of unwitnessed falls, they were because R1 would roll off on the edge of the bed. R1 was able to pick themselves up and go back to bed and reported the incident to staff the following day. R1 declined to go to the hospital and did not request staff to initiate emergency medical services when they sustained bruises from the fall. R1 confirmed that they did not request medical services until they felt sick and weak on 06/21/23. Interview with Administrator indicated that R1 was taken to the hospital after R1 fell in the bathroom, which was confirmed by an employee of the Hospital. Interview with witnesses indicated that R1 was transported to the hospital because of weakness/illness. R1 had been sick and soiled themselves on the bed, but aside from this instance there are no records of R1 being left in urine and feces all night without Staff assistance. Based on the information obtained through interview and record review, there was insufficient evidence to prove the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. Continued on 9099-C On the allegation: Staff could not provide emergency information to paramedics. RP alleged that when paramedics arrived at the facility on 06/21/2023 to transport R1 to the hospital, the paramedics found an individual who seemed like a staff member but could not tell the paramedics anything about R1. The individual then allegedly ran from the paramedics and was not found. RP stated that it seems like the staff don’t know anything about R1. RP stated that the staff didn’t even know why R1 went to the hospital on 06/21/2023. According to an interview with Staff, on 06/21/23, a Staff member of the facility was surprised that paramedics were at the front door of the facility looking for R1. R1 had called 911 without notifying the Staff. Although R1 had a history of unwitnessed falls, they were during when R1 would roll off on the edge of the bed. R1 was able to pick themselves up and go back to bed and reported the incident to staff the following day. R1 declined to go to the hospital and did not request staff to initiate emergency medical services when they sustained bruises from the fall. R1 confirmed to licensing during an interview that they did not request medical services until they felt sick and weak on 06/21/23. R1 was offered to go to the ER on 06/20/23 but they refused. The Staff member was unaware of the reason that 911 was called on 06/21/2023. When paramedics arrived, the Staff member showed them R1’s room and went back to caring for another resident at the facility. Interview with Staff indicated that Staff #1 (S1) was told by R1 that they were not feeling well so R1 called 911 on 06/21/2023. S1 was not aware that R1 needed emergency medical services as they did not communicate it to S1. S1 only found out that R1 called 911 because the paramedics were knocking at the door. S1 was the only staff that worked that day. According to an Incident Report (SIR) received by Licensing from 06/21/2023, S1 gave the paramedics the medication lists for R1 and all recent hospitalization discharge paperwork as requested. Based on the information obtained through interview and record review, there was insufficient evidence to prove the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. On the allegation: Facility is over ratio. RP alleged that that when emergency personnel arrived at the facility on 06/21/2023 to transport R1 to the hospital, there were many people in the facility and it could be over capacity. RP stated emergency personnel could not determine who were residents, caregivers, or family members of the Licensee. Continued on 9099-C Interviews were conducted with the Licensee/Administrator, Staff members, residents, and various witnesses. Through no interview was information gathered that corroborated the allegation that there were more people in the facility than the facility could hold. On 06/23/2023, LPA received an LIS 536 Facility Personnel Report Summary from the Licensing Information System indicating the Associate Status of all employees associated with the facility was cleared. On 05/01/2023 and 06/01/2023, LPA received LIC 500 Personnel Reports from the facility indicating the Name, Job Title, and Duty Schedule of each employee associated with the facility. Based on the information obtained through interview and record review, there was insufficient evidence to prove the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. On the allegation: Staff did not provide adequate medication assistance. RP alleged that they recently discovered R1 went to the hospital on 06/21/2023 for a UTI and was given two new medications for it. RP alleged the facility doesn’t have the medications. RP stated that it is unclear who is responsible for getting resident’s medications. According to information obtained during the investigation, R1 has a history of multiple UTIs. LPA received R1’s Physician Report for RCFE, Centrally Stored Medication and Destruction Record, and Current Medication List. LPA additionally received the Hospital Discharge Summary for R1 from the hospital admission on 06/21/2023 to discharge on 06/27/2023. The Hospital Discharge Summary included a UTI diagnosis during the visit. The hospital discharge summary lists the specific antibiotics required by R1 to take along with physician instructions on correct procedures for the UTI. The Hospital Discharge paperwork also lists Past Medical history including Historical Acute UTI. R1 was given an assessment plan by the Hospital to take Amoxicillin 500mg q8h for the UTI. Discharge instructions include what the medication is for, how much to take, when to take it, and instructions for pickup and duration. All of R1’s medication is documented in R1’s Medication Dosage and Schedule at the facility as well as the Centrally Stored Medication and Destruction Record. Based on the information obtained through interview and record review, there was insufficient evidence to prove the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. Continued on 9099-C On the allegation: Facility is unkempt. RP alleged that that when paramedics arrived at the facility on 06/21/2023 to transport R1 to the hospital, the paramedics stated the facility was “trashed” and unclean. RP alleged that the resident’s room is unkept and resident seems to have been in the same clothes for a while. On 06/21/2023, LPA physically observed the facility and took photographic images of each area of the facility. The photographs taken by the LPA do not show the facility trashed and unclean, aside from a trash can that had not had the garbage taken out. Common areas were photographed to be appropriately furnished, with all furniture in good condition. The restrooms were photographed to be sufficiently stocked with soap, paper towels, and additional supplies. The appearance of the bathroom from the photographic evidence was in good condition. Photographs of the resident bedroom indicated appropriate furnishings and sufficient lighting. Based on the information obtained through interview and record review, there was insufficient evidence to prove the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted. A copy of this Complaint Investigation Report provided to the facility.the state’s words, verbatim · CDSS document, Nov 15, 2023 · control 29-AS-20230621094023