Pre-licensing visit·October 31, 2024

Licensing Program Analysts (LPA) J. Clancy-Czuleger and P Manalo, conducted an unannounced visit to the facility for the purpose of a Pre-Licensing evaluation. LPA was greeting by Irene De Leon, Facility Manager. Administrator, Jeffrey Tong Backup Administrator arrived later. An application was submitted to Community Care Licensing Department (CCLD) for a change of ownership of Residential Care for Elderly 60 years and above. The requested capacity is for (45) Residents, (4) ambulatory and (41) non-ambulatory. Physical plant is not consistent with the facility sketch received by Central Application Bureau (CAB). The facility has two floors, and 22 rooms. The first floor has a lobby, receptionist carea, administrator’s office, activities room, resident rooms, kitchen and dining area. Signal System : Signal system in facility is individual resident pendent call buttons. Bedroom Residents: There shall be no more than two clients per bedrooms. bedrooms are designated resident bedrooms properly equipped with regulation guidelines of two beds, two chairs, and two night stands. Presently, 14 bedrooms are occupied by 2 clients and 6 bedroom by 1 client. Bedroom Staff: No bedrooms will be used for awake staff. Bathrooms: eight rooms have a shared half bath bathroom and 14 rooms have private half bathrooms. There are two visitor and staff bathrooms. The facility is equipped with two shower rooms, one shower room is currently being used as storage for the facility and not ready for residents use. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen is stored where the house keeping supplies are kept. Smoke Detectors: There are hard wired smoke detectors throughout the build and in resident rooms, sprinkler system through the whole facility which are interconnected. Continued on 809C... LPAs observed the following: Facility sketch is not contestant with the building The resident rooms do not have adequate lighting The resident bathroom floors appear to be dirty There is one shower usable for 29 residents water temperature is 123.6 degrees Chemicals were observed unlocked in storage/shower room there is not a compliance poster posted rooms that have oxygen stored do not have signs posted There is not an office space for administrator Upon receipt of the proof of corrections for the items above by November 20, 2024, LPA Clancy-Czuleger will come back out for reinspection. and Component III. Exit interview conducted and copy of this report provided.