Routine inspection·August 14, 2025

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with staff Dennis Bonifacio, and explained the reason for the visit. LPA was informed that Florence Peregrino is no longer administrator of the facility as there was a change within the organization since January of 2025. LPA was given the contact information of Susan Nuguid, the new Administrator and was informed that Mrs. Nuguid is out of the country. Administrator Nuguid had assigned staff Dennis to Bonifaco to sign the report. At approximately 11:15 am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. The laundry area is located through the kitchen. The washer and dryer were observed to be in good condition. No toxins or other hazards items were present. Bedrooms: There were five (5) bedrooms designated for residents' use. Four (4) bedrooms are designated for private use, and one (1) room is shared. All five bedrooms, in use by residents, were properly furnished with appropriate beddings and linens with sufficient lighting. Currently, Room 4 is vacant. LPA was informed that R1 had passed away on or around June 13, 25. LPA conducted a file review and did not observe any death report had been sent out to CCL regarding R1's death. Bathrooms: There were four (4) bathrooms in the facility. One (1) bathroom in hallway and three (3) bathrooms in the private bedrooms. All bathrooms were clean, properly supplied and had functional fixtures. Hot water temperature was 110.6 degrees Fahrenheit. Cleaning supplies were kept in locked cabinets. Temperature: Facility maintains a comfortable temperature of 77 degrees Fahrenheit. (Continue on 809C) Smoke Alarms and Carbon Monoxide: detectors were tested and function properly. Fire extinguisher is located in the kitchen with purchase date 11/4/24. Common Areas : These included the living room and dining area. The common areas were properly furnished with adequate couches, chair, and television. The dining area had a large table, to seat up to six (6) individuals. Furniture in common areas were clean and in good repair. Floors were mopped and clean. Hallways and passageways were clear of any obstruction. Surrounding Grounds : Entry/exits were free of obstruction. LPA observed the outdoor area to be cluttered with unused bedframes, broken exercise machines and outdoor furniture. No lock on the side gate. Resident Files : LPA conducted a file review of two out of 5 residents records to ensure compliance of licensing forms. LPA observed that R2 and R3 Appraisal Needs and Services (LIC 625) are not updated. Staff Files : LPA was unable to conduct staff file review for S1 as there was no physical file for S1. LPA conducted file review for 2 out 2 present staff. LPA requested copy of the liability insurance. LPA was informed that there are no physical copy of the liability insurance on file. LPA was unable to complete the annual inspection during today's visit. The administrator was informed that a follow-up visit will be conducted. Exit interview conducted. Citations issued, appeal rights given, Copy of report provided.