Post-licensing visit·October 7, 2025

On 10/07/2025 at 1:40PM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced post licensing inspection. LPA met with Administrator Jonjie Ligaray and advised on the purpose of the visit. Fire clearance was approved for five (5) non ambulatory and One (1) bedridden resident. Upon entry LPA observed two (2) residents in common area sitting in recliner chairs and one (1) caregiver preparing meal for residents in care. LPA toured facility including but not limited to bedrooms, bathrooms, dining area, living room, kitchen, garage, and outdoor area. The fire extinguisher was observed to be full and last purchased on 01/09/2025. Medications were in a locked cabinet. Comfortable room temperature is maintained at 74 degrees F. Hot water temperature in the shared residents’ bathroom was measured at 111.7 degrees Fahrenheit. Carbon monoxide and smoke detectors were observed in operating condition. The first-aid kit was complete, and hygiene items for resident general use are sufficient. Extra linens and towels were observed. Last fire drill was conducted on 10/07/2025. There are no accessible bodies of water observed. Continue on LIC809C Continued from LIC809 LPA reviewed two (2) residents’ records, and three (3) staff records and they all were complete. The following forms are to be updated and submitted to CCL by 10/14/2025 : LIC 500- Personnel Report LIC 308- Designation of Facility Responsibility LIC 610E- Emergency/Disaster Plan (9 pages) Evidence of Liability Insurance LIC9020 Residents Roster No deficiencies were observed during today's visit. Exit interview conducted and a copy of this report provided to Jonjie Ligaray .