Routine inspection·December 14, 2023

Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct a 1 Year Annual Required visit on this date starting at 9:00am. Upon arrival, LPAs met with Caregiver, Joan Tungcul and explained the reason of the visit. Administrator was not available during visit. LPA toured the facility with Caregiver 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 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 106.5 degrees F. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable foods and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 8/23/2023. Emergency Disaster Plan is current. First aid kit was observed to be complete. Fire drill was last conducted on 6/15/2023. LPA reviewed 5 staff records. 5 of 5 staff are associated and have current first aid training. LPA reviewed 5 residents records. Report continues on LIC 809-C Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 12/31/2023: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Exit interview conducted and a copy of this report provided.