Routine inspection·August 15, 2023

On this day, August 15, 2023, at 11:35 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Harold Dimaguila and Roel Dimaguila, and informed the reason for visit. LPA spoke with Emelita Dimaguila, administrator, who can not come to the facility and authorized Harold Dimaguila to sign and receive this report. Facility has Infection Control Plan that was submitted on August 2, 2022. Facility currently does not have residents, and according to administrator she is planning to begin admitting beginning the month of September. 2023, and in the process of obtaining the $3M liability insurance coverage before admission of first resident. LPA toured the facility inside out with Harold Dimaguila. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Drawer where sharps are kept was observed with lock. Cleaning supplies were kept in the garage cabinets with lock. Fire extinguisher was observed fully charge. Carbon monoxide and smoke detectors were tested and observed in operating condition. Hot water temperature in the ensuite bathroom was tested, and measured at 110.8 degrees Fahrenheit. At 12:16 pm, LPA observed rippped shade in the backyard. ......continued on 809C Administrator to submit the following updated/current documents by August 29, 2023: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) Administrator to submit copy of $3M liability insurance coverage on or before admission of resident. Deficiency is cited from Title 22 California Code of Regulations, and listed on 809D. Failure to submit proof of correction by plan of correction due date, and any repeat violation within 12 month period may result in civil penalty . Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.