Willie Care Home

Type of visit: Required - 1 Year

On 6/30/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Required 1-year Annual inspection. LPA Calandra was greeted by Wusheng Zhao, Administrator/Licensee and explained the purpose of the visit. LPA toured the physical plant. This is a 1-story building with 7 bedrooms, 4 bathrooms, a kitchen, living room, dining room, office, garage, and front and backyards. All bedrooms had the required furniture and sufficient lighting. All bathrooms had the required grab bars and anti-skid flooring. No accessible bodies of water or hazards were observed. The facility's smoke alarms and Carbon monoxide detectors were observed to be in working order. The facility's fire extinguisher was last checked on April 27, 2026 and was observed to be fully charged. The facility's first aid kit was observed to have all of the required items. The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. All sharp objects, soap, detergents, and poisons were observed to be locked and in-accessible to persons in care. LPA reviewed 5 resident files and 4 staff files. All were observed to be complete. During record review, LPA Calandra observed that the Licensee had no record of the 4 hours of required training on postural supports, hospice, and restricted health conditions. A Type B citation was issued for this deficiency. A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. During the visit, LPA Calandra collected the following document: -Liability Insurance Deficiencies are cited under California Code of Regulations(CCR) Title 22. Failure to correct said deficiencies by the Plan of Correction due date may result in Civil Penalties. An exit interview was conducted and a copy of this report and appeal rights provided to the facility representative.the state’s words, verbatim · CDSS document, Jun 30, 2026

Type of visit: Required - 1 Year

On June 03, 2025, the Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. The LPA met with the Administrator, Guili Xu, and disclosed the purpose of the inspection. The Administrator informed the LPA that the facility had (6) residents in care and (2) staff members present at the time. At 1:05 PM, the LPA initiated a walk-through of the facility, accompanied by the Administrator. The indoor temperature reading of 74°F on a thermostat was observed in the hallway at the time of the visit. LPA inspected the kitchen and observed lunch preparation and cooking in progress at the time. The appliances were checked and observed to be in working order. The LPA inspected a locked cabinet under the sink containing detergents, disinfectants, cleaning supplies, knives and sharp objects. The refrigerator and pantry cabinets were inspected, and sufficient supplies of fresh perishable food for (2) days and nonperishable staples for (7) days were observed. No expired food or stored medications were noted. LPA inspected the dining area adjacent to the kitchen. The dining table and chairs were observed to accommodate the residents, and all the furniture was in good repair. Two (2) residents were observed to sitting in the dining area waiting for lunch to be served. LPA inspected the living room and observed a sofa set, chairs, a coffee table, a game table, a covered fireplace, and a television in the living room. One (1) resident was observed sitting in the living room with their family member and playing a game. Board games, puzzles, arts, coloring, audio and video disks, and other recreational activity items for residents’ activities were also observed in the living room. The door screen in the living room sliding door was observed to be broken. Continued on LIC809-C There were six (6) bedrooms and four (4) bathrooms designated for residents' use. All (6) resident rooms were single occupancy. LPA inspected all (6) resident rooms and found them clean, well-lit, and equipped with the required furniture. Storage closets with incontinence supplies were observed in the rooms. LPA inspected four (4) full bathrooms and found them in good working condition. The bathrooms contained soap, grab bars, paper towels, a trash can, a shower chair, and non-slip mats/flooring. The hot water temperature at the sink faucet measured between 116.1°F to 117.5°F in the four bathrooms. LPA observed a washer, and a dryer in one of the bathrooms. The sliding door screen in bedroom #6 was observed to be broken. LPA inspected the fire extinguisher mounted on the wall in the hallway and found it fully charged, with the last service tag dated 05/02/2025. The Administrator tested the smoke and carbon monoxide detector located in the living room in the LPA's presence, and it was found to be functional. Additional smoke and carbon monoxide detectors were observed in all bedrooms and common areas of the facility during the visit. LPA observed a linen closet with bedsheets, blankets, and towels in the hallway. LPA observed a locked closet in the hallway containing cleaning solutions, disinfectants, and incontinence supplies. LPA inspected the garage and observed the garage containing racks with shelves containing extra dry food items, incontinence supplies, and paper products. LPA toured the backyard area and found ramps and passageways in good condition, clear of obstructions, with no blocking or tripping hazards. The backyard had a set of a patio table, chairs, and umbrella for resident use. No accessible bodies of water were found. LPA inspected two (2) storage shed and observed tools, wheelchairs, walkers, and furniture items in the shed. LPA reviewed five (5) staff personnel records and five (5) resident records. The LPA observed that 5 of 5 residents had an Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, and CSDMR. LPA observed that 1 of 4 staff members didn’t have LIC 503 Health Screening. LPA confirmed that 4 of 4 staff members were associated with the facility. LPA observed a locked centrally stored medication cabinet located inside in the dining area next to the kitchen. Medications were organized separately for each resident. All medication bottles and bubble packs were properly labeled. Centrally Stored Medication Records were reviewed and found to be complete. Continued on LIC809-C LPA inspected the first aid kit and found it fully stocked. LPA reviewed Emergency Drill Logs and observed Emergency Disaster Drills were conducted quarterly, with the most recent drill completed on 04/06/2025. The following updated forms are requested to be submitted to CCLD by 06/10/2025: · LIC 500: Personnel Report · LIC 308: Designation of Facility Responsibility · Certificate of Liability Insurance · Administrator Certificate(s) The deficiencies are being cited based on LPA observations, records reviewed, and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted, and Plans of Correction were reviewed and developed with the Administrator. A copy of this report and appeal rights were discussed and provided to the Administrator, Guili Xu, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jun 3, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's required - 1 year annual inspection. LPA met with Licensee Guili Xu and Administrator Wusheng Zhao. During visit, LPA toured the facility with Licensee to include the resident bedrooms, staff bedrooms, living room, office, kitchen, garage, and backyard. LPA observed the sheds in the backyard contains storage items. All fire exits routes are free and clear of obstruction. Facility temperature maintained at 76 degrees Fahrenheit. 3 staff and 1 live-in individual present are fingerprint cleared and associated to the facility. Facility has a carbon monoxide detector present. Fire extinguisher last serviced on 03/01/2024. Kitchen observed with at least 2 days worth of perishables and 7 days worth of non-perishable foods. Refrigerator temperature maintained at 51 degrees Fahrenheit. Licensee was advised. Freezer temperature maintained below 0 degrees. Items inside the refrigerator observed covered. During visit, Administrator adjusted the temperature control of the refrigerator which will take about 24 hours to adjust. Fruits observed in the dining room. Sharp objects (such as kitchen knives), disinfectants, and chemicals observed secured inside the same cabinet in the kitchen. LPA advised to separate the chemicals and kitchen knives to avoid cross contamination. Licensee states they normally store the chemicals in a separate storage space. Administrator immediately moved the chemicals to another secured location. Medications observed locked. Bathroom hot water temperature in the hallway maintained at 117 degrees Fahrenheit. The bathrooms contains accessible hygiene products. Based on review of resident records, 6 out of 6 resident's are not as risk if provided access to hygiene items. SEE LIC812-C. LPA observed 6 resident rooms contained adequate lighting, a bed, chair, night-stand and dresser. 6 out of 6 resident beds observed with half bed rails. Licensee was unable to provide the physician's order for half bed rails for 6 residents. During visit, Licensee obtained a physician's order for half bed rails for 5 residents. Licensee was advised. 3 out of 6 residents are under hospice care. The facility only has an approved hospice care waiver for 2 residents. Licensee was advised. LPA reviewed 6 resident records. Based on record review, 3 residents are noted to be bedridden. Licensee states 2 out of 3 resident's physician's report dated 06/13/2024 is incorrect and believes the residents are actually non-ambulatory. During visit, the Licensee contacted R1 and R4's doctor for clarification and obtained an order stating the 2 residents are non-ambulatory. Licensee was reminded of their approved fire clearance. Licensee states understanding. Licensee will ensure to update the resident's physician's report to reflect the correct ambulatory status. 6 out of 6 resident records contains an admission agreement, updated physician's report, TB result, updated appraisal/needs and services plan, consent forms, and personal rights. LPA reviewed 2 staff records contained a fingerprint clearance, 1st aid certification, TB result, and employee rights. 1 out of 2 staff members was recently hired as of May 2024. Licensee states the new staff is provided training but licensee was unable to produce the completed training documentation. Licensee was advised to ensure the training documentation is filled out for new staff. Licensee stated understanding. Facility has an emergency disaster plan. Flashlight, batteries and first aid kit observed. The last emergency drill was conducted on 03/15/2023. Licensee advised. LPA observed the facility has PPE supplies. Documents were obtained to include Administrator Certificates and Liability Insurance. LPA requested Licensee to submit the LIC500, Emergency Disaster Plan, and Infection Control Plan by 06/25/2024. Deficiencies were cited today per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with Licensee Guili Xu and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 24, 2024