Acacia Manor

On June 18, 2025, Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with the administrator, Luzviminda Tan and LPA explains the purpose of today's visit. LPA toured the facility inside and out and inspected the living room, dining area, kitchen, bedrooms, bathrooms, and backyard. The indoor and outdoor passageways were free of obstruction. The facility has 4 resident rooms and 4 bathrooms. Furniture and furnishings were observed to be sufficient. Food supplies were sufficient of 2- days perishables and 7- days of non-perishables. Toilet, hand washing and bathing areas were observed clean and in operating condition. Showers were observed equipped with non-skid mats and grab bars. Comfortable temperature is maintained and lighting is sufficient for comfort. Central storage for medications, sharps and chemicals were observed to be locked and inaccessible to residents in care. Hot water temperature in the kitchen and bathroom were measured at 107 degrees Fahrenheit. Fire extinguishers were checked. A review of (2) resident files was conducted and noted on the LIC 858. A review of (1) staff files was conducted and noted on the LIC 859. LPA requested for a copy of the Liability Insurance and a copy of the Administrator Certification to be submitted to CCL by 6/23/2025. No deficiency is cited today. This report is reviewed and discussed with the administrator; a copy is provided.

On May 30, 2024 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with caregiver, Evelyn Balaga and explained the purpose of the visit. The administrator, Luzviminda Tan arrived shortly thereafter and assisted with the inspection. LPA toured the facility inside and out and inspected the living room, dining area, kitchen, bedrooms, bathrooms, and backyard. The indoor and outdoor passageways were free of obstruction. The facility has 4 resident rooms and 4 bathrooms. Furniture and furnishings were observed to be sufficient. Food supplies were sufficient of 2- days perishables and 7- days of non-perishables. Toilet, hand washing and bathing areas were observed clean and in operating condition. Showers were observed equipped with non-skid mats and grab bars. Comfortable temperature is maintained and lighting is sufficient for comfort. Central storage for medications, sharps and chemicals were observed to be locked and inaccessible to residents in care. Hot water temperature in the kitchen and bathroom were measured at 107-110 degrees Fahrenheit. Fire extinguishers were checked and last inspected on 8/25/2022. A review of (1) resident files was conducted and noted on the LIC 858. A review of (1) staff files was conducted and noted on the LIC 859. No deficiency is cited today. This report is reviewed and discussed with the administrator; a copy is provided.

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - 1 Year visit on 10/7/23 at 5:30PM. LPA met with Luzviminda Tan , Administrator and stated the purpose of the visit. The facility is licensed for a capacity of 6 non-ambulatory residents in rooms 2,3 and 4 of which 3 may receive hospice care services. There are 2 residents receiving hospice services at this time. The Administrator Certificate was observed for Luzviminda Tan which expires 8/26/24. LPA observed residents and conversed with them during this visit. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 78.1*F which is within the required range of 68-85*F. The hot water temperature was measured at 105 *F which is within the required range of 105-120*F. Facility has a tankless water heater. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA observed 1 staff and 2 resident files and conducted interviews during this visit. Upon a file review the following items were discussed to be submitted with any changes annually: Any Addendums to the Infection Control Plan, Plan of Operation, Designation of Facility Responsibility (LIC308), Personnel Report (LIC500) to include the Administrator presence in the facility, Administrator Certificate-Updated, Emergency Disaster Plan (LIC610E), Plan of Operation, Plan for incidental and Medical and Dental Care, Health Screening with TB, Transportation Procedures, and Liability Insurance. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited. An exit interview was conducted, a copy of the report was given.