Routine inspection·January 12, 2026

On 1/12/2026 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct the required Annual Inspection. Upon arrival, LPA was greeted by the Administrator designee Estelita Agpao, who granted access to the facility. LPA explained the reason for the visit. LPA Khurshudyan reviewed the required postings posted on the wall of dining and living room areas and requested staff and residents’ rosters for review. The inspection tool was used to complete the visit. At 12:10pm LPA, with the help of the Administrator designee, began a physical plant tour of the facility and the following was observed: This is a single-story building with six (6) bedrooms, of which five (5) rooms designated for residents’ use. There are three (3) bathrooms, a kitchen, common areas: living and dining rooms, and an outdoor area. Facility has an approved fire clearance for five (5) Non-ambulatory residents, bedridden resident for room #2, and a Hospice waiver for one (1) resident. Kitchen: LPA observed a seven-day supply of non-perishable food, and a two-day supply of perishable food properly stored and labeled. No expired food was observed. Facility stores knives and sharps inside the locked kitchen cabinet, however, at the time of the visit the knife/sharps cabinet was unlocked. Emergency supply of food / water was stored inside the pantry. Food storage and preparation areas are clean and inaccessible to pests. LPA observed two (2) fire extinguishers located in the kitchen and next to the entrance area. The fire extinguishers were last serviced on 5/16/2025. Dish soap and other chemicals observed to be stored under the sink, however, at the time of the visit LPA observed the cabinet to be unlocked and available to residents in care. Continue on LIC809-C Bedrooms: There are six (6) bedrooms in the facility, of which five (5) bedrooms are for residents’ use. LPA observed bedrooms to be properly furnished with beds, linens, night stands, chairs, drawers, closets, and adequate lighting. All bedrooms appeared organized and clean. Residents have enough personal hygiene products. Common Areas: These include living and dining areas . LPA observed dining, living areas clean and clear of clutter. Furniture is generally new and in a good repair. Dining and living room furniture sits at the capacity of the facility. Walls, floors, windows, screens, and blinds were clean and in good repair. At 12:35pm, LPA measured the room temperature to be 70 degrees Fahrenheit. There is a linen closet with an adequate supply of fresh linens ready to use. No obstructions and or tripping hazards found inside the facility. Facility has landline, LPA checked it was operational. Bathroom: There are three (3) bathrooms in the facility. The bathrooms contained hand soap, paper towels, toilet paper and trash bins with lids. The hot water temperature was measured at approximately 12:50pm to be 108.5 degrees Fahrenheit. The bathrooms were checked for cleanliness and proper operations. Towels and washcloths are not shared. LPA observed all bathrooms were missing non-skid mats and was informed by caregiver that facility uses towel in place of non-skid mat. Smoke and Carbon Monoxide Detectors: The smoke and carbon monoxide detectors were tested by staff at 2:30pm and were observed to be operational. Garage: There is no garage in the premises. Laundry Room: Functioning washer and dryer are in a separate laundry room located next to the kitchen area. Laundry detergents and other chemical supplies observed to be unlocked and accessible to residents in care. Backyard/Front yard: LPA observed sufficient yard space and fenced backyard. The front yard has appropriately covered shaded area available for clients to rest. There is outdoor furniture under the shaded area. LPA discussed the importance of maintaining care and supervision to meet the needs of clients. During the physical walk through LPA observed exit area to be cluttered with old/broken furniture and other items, and the obstructions were present around the emergency exit area. There is no body of water in the property. Staff/Client File review: Facility records are kept in the office area next to the living room. Files observed unlocked inside the built-in shelf. Between 12:55pm -2:25pm LPA conducted records review of four (4) staff files and five (5) residents’ records. Files were complete and updated. Continue On LIC809D Medications : At approximately 2:15pm. LPA reviewed Centrally Stored Medication Destruction Records for proper documentation. The facility also maintains Medical Administration Records (MAR). LPA observed centrally stored medications locked inside the medication closet and inaccessible to residents in care. Complete First-aid kit is also available and placed in the common area. No potentially dangerous items were found in the facility. The facility operates with two (2) shifts and has two (2) staff members for each shift. LPA conducted an interview with an Administrator designee, two (2) caregivers and three (3) out of five (5) residents who agreed to communicate. Facility plan/sketch is posted on the wall along with other posting requirements. LPA was unable to collect LIC500, LIC9020, and was unable to verify the coverage of Liability Insurance at the time of the visit. LPA was informed that copies will be forwarded the following day via email. The Administrator's certificate - Exp date is 6/22/2026. Deficiencies issued during today’s visit, see LIC809D. Exit interview conducted, Appeal rights provided, a copy of this report signed and delivered.