Routine inspection·January 4, 2024

Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct a 1-Year Annual Inspection on this date starting at 9:25am. Upon arrival, LPA met with Caregiver, Anastacio Andimat Jr. and Assistant Administrator, Marjorie Osia. Administrator Gina Licup arrived at 11:30am. The facility's fire clearance is approved for all residents may be non-ambulatory. LPA toured facility with Assistant Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees F. 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 118.8 degrees F. 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. LPA observed carbon monoxide and interconnected smoke detectors were observed during visit. Fire extinguisher was last serviced on 10/3/2023 . Emergency Disaster Plan was last posted on 1/02/2024 . First aid kit was observed to be complete. Fire drill was last conducted on 12/20/2023 . LPA reviewed 3 staff records and 3 of 3 are associated. LPA reviewed 4 residents records 4 of 4 residents have appraisals of needs and services. Report continues on LIC809-C Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 1/19/2024: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate No deficiencies cited during visit. Exit interview conducted with Administrator and a copy of this report provided.