Tri City Care Home

On 12/5/2024 at 9:00 am, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct an annual required inspection and met with staff care staff, Rachiel Dime. The Administrator Belen Rodrigues was informed over the phone about the purpose of the visit. The Administrator (Administrator holds a certificate #6021647740 expiration 12/16/26 arrived at the facility at around 1PM. LPA inspected the facility inside and out including but not limited to bedrooms, bathrooms, dining room, kitchen, living room and outdoor area. The facility’s temperature was maintained at 73 degrees Fahrenheit. Bathrooms have grab bars and non-skid mats. The facility has appropriate lighting throughout. Extra linens and towels were observed in the hallway closet. Hot water temperature measured 115 degrees Fahrenheit. There were sufficient supplies of perishable and non-perishable foods. First aid kit was observed completely and updated. Fire extinguisher was last inspected on 3/05/2025. Fire Drill last conducted 10/17/25. Emergency disaster plan last updated on 10/17/25. Facility has an effective liability from 1/17/25 to 1/17/26. LPA reviewed 6 resident files and 4 staff files. All staff are fingerprint cleared and associated to the facility. All staff have current First Aid and CPR training. Report 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 Deficiencies observed: At around 10:40 am, LPA observed Clorox and Lysol spray in basket near front entrance. Chemical left underneath the sink. Disinfected wipes left in bathroom. LPA observed knives on table near front door. At around 10: 50am, LPA observed multiple expired and mold food including but not limited to salad dressing, cheese, salad, bell pepper, cans good, and ect. At around 11am, LPA observed containers with food are not labeled properly. At around 11:30am, LPA observed prescribed medication including but not limited to cream, in resident rooms. At around 12pm, LPA conducted files reviewed there is no Liability insurance. Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties. Exit interview was conducted and Appeal Rights were provided . Administrator agrees to check all residents’ rooms and lock all medication in a lock area. Administrator agrees to conduct training for all staff and submit proof to CCLD by POC date.

On 12/20/2021 at 9:30 AM, Licensing Program Analysts (LPAs) L. Holmes and C. Fowler arrived unannounced to conduct an Infection Control Inspection. LPAs met with Carmen Roxas, Caregiver and explained the purpose of the visit. Administrator, Belen Rodriquez was called about 15 minutes after visit started and advised would arrive later. Licensee arrived at 12:00 pm. Upon entry, LPA's temperatures were checked. LPAs toured facility including but not limited to bedrooms, bathrooms, kitchen, outdoor areas and garage. LPAs observed some sign & symptoms, cough etiquette, and social distancing that were posted in the common and hallway areas. Hand washing posters were posted at bathrooms and sinks. During record review, LPAs observed visitors log and temperature logs for both residents and staff. A copy of the Mitigation Plan is on file. LPAs observed some PPEs, food, and paper supplies that are sufficient. The following deficiencies were observed during the visit: -At 9:55 am, LPAs observed unlocked knife. At 10:04 am, unlocked vitamins. At 10:20 am, unlocked cleaning supplies were observed in the unlocked garage. At 10:25 am, an unlocked shed with gardening tools was observed in the backyard. The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct deficiencies may result in Civil Penalties. Exit interview conducted. A copy of this report and appeal rights provided.

On 12/5/2024 at 9:30 am, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct an annual required inspection and met with staff care staff, Mathew Aviles. The Administrator was informed over the phone about the purpose of the visit. The Administrator (Administrator cert#6021647740 expiration 12/16/24) arrived at the facility at around 10:15am. LPA inspected the facility inside and out including but not limited to bedrooms, bathrooms, dining room, kitchen, living room and outdoor area. The facility’s temperature was maintained at 73 degrees Fahrenheit . Bathroom have grab bars and non-skid mat. The facility has appropriate lighting throughout. Extra linens and towels were observed in the hallway closet. Hot water temperature measured at 115.3 degrees Fahrenheit. There were sufficient supplies of perishable and non perishable foods. First aid kit was observed complete and updated. Fire extinguisher was observed that appeared full and has purchase date of 2/25/2024. Fire Drill last conducted 10/14/24. Emergency disaster plan last updated on 3/21/24. Liability insurance effective 1/17/2024 to 1/17/25. LPA reviewed 6 resident files and 3 staff files. All staff are fingerprint cleared and associated to the facility. All staff have current First Aid and CPR training. At around 10:15 am, LPA observed cheese, and tomato have mold in the refrigerator. Cleared At around 10:25am, LPA observed ant, roach, and spider (hot shot) spray inside room 4 bathroom. Cleared At around 10:40am, LPA observed residents’ medication are not in its original container. Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties. Exit interview was conducted and Appeal Rights was provided .

This is an amended copy of the report previously issued to the facility on 3/21/2024. This report was erroneously pulled from the incorrect facility. The amended report can be found under Tri City Care Home ll Lic #015601359. LPA Luisa Fontanilla arrived at the facility at around 1:20 pm to amend report previously issued on 3/21/2024. The Administrator was informed about the visit and she authorized staff Wilma Bernal to sign the report. A copy of this report was provided to Bernal. 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 Exit interview was conducted and Appeal Rights was provided to Rodriguez .