Lucky Garden Care Home

On 05/08/2025 at 8:50 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Care Staff, Na Liu and explained the purpose of the visit. Administrator (ADM) Isabella Joe was contacted by the phone and arrived shortly after. The Administrator holds a certificate #7002486740 and expires on 11/28/2025. LPA toured facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms which 3 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 71 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 105.9 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was purchased on 05/08/2025. Emergency Disaster Plan was last posted on 03/15/2025. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 04/01/2025. Continue to LIC809-C... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Continue from LIC809... At 9:59 AM, LPA reviewed 3 residents records. At 10:44 AM, LPA reviewed 2 staff records and 2 of 2 have current first aid training and associated to the facility. At 11:11 AM, LPA reviewed two samples of resident’s medications. All records were observed to be complete and up to date. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 05/16/2025: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report THE FOLLOWING DEFICIENCY WAS OBSERVED DURING VISIT: At 11:30 AM, LPA observed scissors, screwdrivers, and Lysol wipes unlocked and accessible to residents. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiency by POC date may result in additional Civil Penalties. Exit interview conducted with Administrator. Appeal Rights and a copy of this report provided.

On 05/16/2024 around 11:30 AM, L. Holmes Licensing Program Analysts (LPA) L. Hall arrived unannounced to conduct a required Annual Inspection. LPA was greet by a Care Staff, and explained the purpose of the visit. Isabella Joe, Administrator (ADM), was contacted by phone and said she'd arrive in about 10 minutes; ADM arrived around 12:00 PM. The Administrator holds a certificate #600897740 that expired 11/28/23; Guardian is delayed in processing certificates. The facility’s fire clearance was approved for six (6); two (2) may be non-ambulatory residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, front yard, and back yard. The facility consists of four (4) bedrooms, a staff resting area/office, and three (3) bathrooms. All outdoor and indoor passageways are free of obstruction. A comfortable temperature was maintained at 74 degrees Fahrenheit (F). LPA observed lighting in all rooms to be adequate for the comfort and safety of all residents. The hot water temperature in the residents’ shared bathroom was measured at 107.7 degrees Fahrenheit (F). Residents’ bathrooms were equipped with grab bars and non-skid flooring. There was a 7-day supply of non-perishables and 2-days of perishable foods. Smoke detector and carbon monoxide units were in operating condition. Fire extinguisher was last serviced on 03//19/24. Emergency Disaster Plan to be updated. First aid kit was observed to be complete. Continued on LIC 809C... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 ...continued from LIC 809. - Post LIC 610D Emergency Disaster Plan - Review client and resident files for signatures. - Provide photos of cleared cob webs inside and outside of home - Updated facility sketch - LIC 200 - Update and post LIC 500 The following deficiency was observed. -At 3:15 PM, LPA observed there was not an updated fire clearance inspection for two ((2) of the four (4) non-ambulatory residents. The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in Civil Penalties. Exit interview conducted, Appeal Rights and a copy of this report provided to Isabella Joe (ADM).

On 4/21/2023 starting at 9:25 AM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with JOE, ISABELLA- Licensee and explained the purpose of the visit. The licensee administrators certificate is valid and expires on 11/28/2023. The facility’s fire clearance was approved for all four (4) ambulatory residents, two (2) non- ambulatory residents and two (2) hospice waivers. Upon entry, LPA observed two (2) staff and five (5) residents present during inspection. Starting at 10:20 AM, LPA toured facility with licensee including but not limited to four (4) bedrooms, three (3) bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms which 1 bedroom is private, and 3 bedrooms are shared. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 68 Degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents'. The hot water temperature in residents’ common area bathroom was measured at 107.6 Degrees Fahrenheit. Residents’ bathrooms are equipped non-skid mats. There is a minimum of one-week supply of nonperishable and 2-day supply of perishable foods. Sharps and toxins were locked and inaccessible to residents'. Smoke detectors and carbon monoxide detector were in operating condition. Fire extinguisher was observed last serviced on 3/4/2023. First aid kit was observed to be complete. Continue on Lic809-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Continued from Lic809 Starting At 11:20 AM, LPA reviewed 2 of 2 staff records. At 12:12 PM, LPA reviewed 5 of 5 residents' record. At 1:15 PM, LPA attempted to review a sample of 5 of 5 residents' medications, however, residents MAR was not filled out for the year of 2023 and LPA was not able to verify residents' medication. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies and/or repeat deficiencies within a 12-month period may result in civil penalties. At 11:30AM, LPA observed S1 with no CPR training. At 11:40AM, LPA observed S2 with no First aid and CPR training in his file. At 1:10PM, LPA observed no MAR created for R1, R2, R3, R4, AND R5 for the year of 2023. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 4/5/2023: · LIC 308 Designation of Administrative Responsibility · LIC 500 Personnel Report · LIC 610E E mergency Disaster Plan (9 Pages) · Liability Insurance Exit interview conducted with Licensee, and a copy of this report provided along with appeal rights.