Family Affair Care Home

On March 4, 2026 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with caregivers Marcelo Sumalnap, Manny DeLeon and Allea Lacuesta and LPA explained the purpose of the visit. Caregivers called and informed the administrator Hui C. Leslie of the inspection and administrator arrived shortly thereafter to assist with the annual inspection. LPA toured facility and grounds. No accessible bodies of water. LPA toured inside and outside including all of resident rooms, living room, common areas, and kitchen area. The indoor and outdoor passageways were free of obstruction. This is a double story home. The first floor consists of 7 resident rooms of which 3 share rooms and 4 private room, 3 full bathrooms and 2 half bathrooms. The second floor has 2 staff rooms and a full bathroom. Bed sheets, linens, and towels were observed to be sufficient and able to meet the needs of the residents at this time. 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. 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 96-151 degrees Fahrenheit. 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 On March 4, 2026 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with caregivers Marcelo Sumalnap, Manny DeLeon and Allea Lacuesta and LPA explained the purpose of the visit. Caregivers called and informed the administrator Hui C. Leslie of the inspection and administrator arrived shortly thereafter to assist with the annual inspection. LPA toured facility and grounds. No accessible bodies of water. LPA toured inside and outside including all of resident rooms, living room, common areas, and kitchen area. The indoor and outdoor passageways were free of obstruction. This is a double story home. The first floor consists of 7 resident rooms of which 3 share rooms and 4 private room, 3 full bathrooms and 2 half bathrooms. The second floor has 2 staff rooms and a full bathroom. Bed sheets, linens, and towels were observed to be sufficient and able to meet the needs of the residents at this time. 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. 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 96-151 degrees Fahrenheit. 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 Facility is equipped with smoke detectors and carbon monoxide detectors. Fire extinguisher was last inspected on 3/17/2025. A review of (5) resident files was conducted and noted on the LIC 858. A review of (5) staff files was conducted and noted on the LIC 859. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with administrator. A copy is provided and the appeal rights.

On March 26, 2025, Licensing Program Analyst (LPA) Murial Han conducted an unannounced continuation visit for an annual inspection that was conducted March 18, 2025. LPA met with the administrator and explained the purpose of today's visit. During today's visit: LPA reviewed 7 resident files, and conducted facility tour that was provided by the administrator. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.

On 3/18/2025, Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with caregivers Marcelo Sumalnap ad Thelma Olson and explained the purpose of the visit. The administrator Hui C. Leslie and the assistant administrator, Xue F Huang arrived shortly thereafter to assist with the annual inspection. Upon entry, LPA observed S3 and S4 were working and based on record review, both of them did not have a criminal background clearance. LPA informed the administrator to remove S3 and S4 immediately. LPA toured the facility and grounds. No accessible bodies of water or fire safety hazards observed. This is a double story home. LPA toured the first floor and observed 7 resident rooms of which 3 share rooms and 4 private rooms. LPA observed 3 full bathrooms and 2 half bathrooms. Bathrooms were equipped with liquid soap, paper towels and a trash can with a fitted lid. LPA observed extra linen. During today's visit, LPA observed garage was cluttered, uncleaned cat food all over the ground, files, dirty plastic bags on the floor, table, unknown brown liquid bottle on the table, lighter, cigarettes on top of the laundry, and soiled linens on the floor. LPA reviewed 4 staff files. Civil penalty of the following in being assessed today in the amount of $2000: - $500 x2 for Criminal Background Clearance - $250 x2 for repeat violations that were identified from the annual visit on March 20, 2024: 87412(a) and 87355(e)(4) 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 LPA will return on another day to complete the inspection. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in additional civil penalties. This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.

On 3/20/2024, Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with manager, Mario Aguiles and explained the purpose of the visit. The administrator Hui C. Leslie and the assistant administrator, Xue F Huang arrived shortly thereafter to assist with the annual inspection. LPA toured the facility and grounds. No accessible bodies of water or fire safety hazards observed. This is a double story home. LPA toured the first floor and observed 7 resident room ; two of which are shared rooms with beds 6ft apart. LPA observed 3 full bathrooms and 2 half bathrooms. Bathrooms were equipped with liquid soap, paper towels and a trash can with a fitted lid. LPA observed extra linen present and first aid kit to be completed. LPA observed medication cabinet to be locked and inaccessible to residents in care. LPA observed living room and dining room to be clean and free from any tripping hazards. A comfortable temperature is maintained and lighting is sufficient for comfort. Overall the facility is odor-free and in good repair. LPA toured the kitchen and observed 2 day perishable and 7 day non-perishable LPA reviewed 4 resident files and 4 staff files. Hot water temperature is measured at 105- 111 degrees F. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.

In response to application for capacity increase from 6 to 10 beds, LPA Jeung inspected physical plant and observed residents. Fire clearance has been approved for 7 non-ambulatory and 3 bedridden elderly persons. Staff reside on the upper level of this 2 story home; there are 2 beds in each room. According to administrator, Ms. Leslie, staff are awake at night. There is a full bathroom on the 2nd floor for staff. On the ground level, there are 6 bedrooms and 4 bathrooms; 3 bathrooms are designated for residents and one is for staff use. Two rooms were constructed on the east side of house. A partial wall has been erected dividing the large rear bedroom on the west side of the house; there is an 8 inch open space above the wall, so the rooms are NOT fully enclosed as bedrooms, as required by San Bruno City Planning Dept. Deficiencies of the California Code of Regulations, Title 22 are observed and cited on a following page> The following forms are requested to be submitted to CCLD by 10/31/22: - Personnel Report (LIC500) - Emergency Disaster Plan (LIC610E)-- must be maintained in facility - Bedridden Plan of Operation Approval of capacity increase is pending receipt of the above referenced items and numbers added to client rooms. Bedrooms are not identified by number. Numbers to be added to bedroom doors for identification. The bedroom with the partial wall can be numbered and designated "A" and "B". Ms. Leslie is advised that an emergency signal system is required if staff are NOT awake at night.

On 5/10/22, Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit to deliver the findings of complaint # 14-AS-20211207111332. LPA Han met with Lead Caregiver, Ganalyn and explained the purpose of the visit. LPA Han also spoke to administrator, Leslie Hui over the phone explaining the purpose of today's visit. During the investigation of the above complaint, the administrator stated that the facility did not conduct a pre-admission appraisal prior to resident #1 (R1)'s admission. Therefore, the facility was not aware of R1's blood sugar management that was required and prescribed by R1's physician. Based on the complaint investigation, the facility failed to preform a pre-admission on R1 to ensure R1 is suitable for the facility. During the investigation of the above complaint, the reporting party stated that R1 was not able to administer insulin, therefore, staff #1 (S1) would be administering it for R1 but the reporting party was not sure if S1 is qualified to do that. As part of the investigation, LPA interviewed administrator who stated that facility has a phlebotomist who is certified to administer injections would go to the facility 2x/day administering insulin injections for resident(s). LPA interviewed resident #2 (R2) regarding to the facility's protocol on administering injections and R2 stated that S1 administered it on a daily basis as R2 was not physically capable of doing it. 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 During the 2nd interview with administrator, the administrator confirmed that S1 was not a skilled professional nor a phlebotomist, and he/she just learned that S1 was administering injections as the phlebotomist was too busy to do it. Based on the complaint investigation, the facility failed to ensure injections are administered by the resident or by an appropriately skilled professional. Deficient is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. Report was discussed with the administrator. A copy of this report and the Appeal Rights is provided.