Pre-licensing visit·April 16, 2025

On 04/16/2025 at 2:55 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct Pre-Licensing inspection. LPA met with Caregiver, and explained the purpose of the visit. phoned the Administrator, Joy Dela Cueva to inform. Joy arrived shortly and called the pending Licensee, Gina Te, to inform of the pre-licensing visit. LPA spoke with Gina, that stated they give authorization to Joy to sign the reports. The facility currently has three (3) residents. Administrator Certificate #7004869749 Expires 06/25/2026. LPA toured facility with Joy including but not limited to six (6) bedrooms, two (2) bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 73 degrees F. and hot water temperatures was measured at 113.4 degrees F (Bathroom #1) and 114 degrees F (Bathroom #2). LPA observed 2 days supply of perishable and one week supply of non-perishable foods. First-aid kit was observed to be incomplete. Emergency Disaster Plan, contact information and personal rights were observed posted in common areas. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 08/21/2024. LIC809-C Continued... LIC809-C (Page3) THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 3:25 PM LPA observed in detached garage three (3) rooms that included windows and hardwood floors: Room 1: a bed, storage file cabinets; Room 2: table, couch, fan, boxes and other items; and Room 3: desk, desk chair, file cabinets, hung wall painting on the wall. In this space there was also a lounge chair in the front entrance and refrigerated freezer At 3:30 PM LPA observed in rear back yard area a ladder laying on the ground against the shed, a shower chair, dried roller paint brush, dried paint tray, 1/2 bed rail, metal, 2 other white items laying on the ground against the side of the shed. At 3:31 PM LPA observed a medication cabinet covered with a plastic tarp located behind the rear of the shed storage. The following will need to be completed before recommending licensure to Centralized Application Bureau (CAB): 1. Updated facility sketch submitted to CCLD that indicates the use of the three (3) rooms located in detached garage. Fire Inspection will have to be scheduled and complete a new inspection of detached garage. 2. COMP III Presentation Pre-Licensing is incomplete with deficiencies to be resolved b y 04/23/2025 . A follow up Pre-licensure LIC809 will be generated upon resolution of deficiencies. Exit interview conducted and a copy of this report provided.