Routine inspection·July 30, 2025

On 7/30/2025 at 10:15 am, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct 1-Year Annual Required inspection. LPA spoke with Administrator (AD), Banaag Yamsuan via telephone and LPA told AD that they arrived to conduct the visit. AD arrived to the facility at 10:45 am and LPA explained the purpose of the visit. The facility’s fire clearance was approved for four (4) Non-ambulatory residents. Hospice waiver for two (2) residents. LPA toured facility with the AD including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of four (4) total bedrooms which 4 bedrooms are occupied by the residents. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 75 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 106.1 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 8/22/2024. Emergency Disaster Plan was last posted on 09/04/2024. First aid kit was observed to be complete. (Continued from LIC809...) LPA reviewed four (4) residents records and six (6) staff records. LPA reviewed a sample of resident’s medications. LPA reviewed four (4) resident's P & I. The following forms will be updated and submitted to CCLD by 8/6/2025: LIC610D: Emergency disaster plan (last page) LIC500: (Personnel Record) No deficiencies cited during visit. Exit interview conducted and a copy of this report pro vided.