Routine inspection·March 22, 2024

On 03/22/2024 at 2:15 PM, Licensing Program Analyst (LPA) Lori Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregivers, Josefina Luy and Delma Ong and explained the purpose of the visit. Josefina phoned, Administrator, Victoria Lingbanan to inform. Victoria arrived at 3;30 PM. The facility’s fire clearance was approved for capacity six (6) residents. In which, all may be non-ambulatory. Hospice waiver approved for one (1) resident. Administrator Certificate # 6006625740 expired 11/25/2023. LPA toured facility with Josefina including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 5 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 197.4 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. Centrally stored medication and sharps were locked and inaccessible to residents. LIC 809-C Continued... LIC 809 Continued... Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 02/15/2023. Emergency Disaster Plan was last posted on 01/15/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 02/2024. LPA reviewed 4 residents records. LPA reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 03/29/2024: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan - Reviewed Liability Insurance Current Administrator’s Certificate - Renewed No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.