Routine inspection·July 28, 2025

On 7/28/2025, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct a required Annual Inspection. Upon arrival LPA was greeted by the Caregiver Dunhill Tolantino, who granted access to the facility. LPA introduced herself by showing her department badge and explained the reason for the visit. The facility Administrator was contacted by phone. LPA Khurshudyan reviewed the required postings on a wall throughout the facility. The inspection tool was used to complete today's visit. At 9:45am LPA, with the help of the caregiver, began a physical plant tour of the facility and the following was observed: This is a single-story building with four (4) bedrooms, two (2) bathrooms, kitchen, garage, common areas, and outdoor areas. This facility is a Residential Care Facility for the Elderly (RCFE). A fire clearance was approved for six (6) Non-Ambulatory residents and one (1) Bedridden resident. The facility also has Hospice waiver for three (3) residents. The smoke alarms and carbon monoxide detectors are hard wired and inter-connected; they were tested and are operational. The facility has two (2) fire extinguishers that were last service on 3/10/2025: the first one is located by the entrance, on the wall, and the second one is located inside the bedroom #2. 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 under the sink inside the locked cabinet. An emergency supply of food / water was stored inside the kitchen cabinets and pantry. Food storage and preparation areas are clean and inaccessible to pests. A weekly menu was also available for clients. Continue on LIC809-C Bedrooms: There are four (4) bedrooms in the facility, of which three (3) are designated for clients use and one (1) bedroom for staff use only. Residents’ bedrooms are shared. LPA observed bedrooms to be properly furnished with beds, linens, night stands, chairs, drawers, closets, and adequate lighting. All bedrooms appeared organized and clean. 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 10:20am, LPA measured the room temperature to be 74 degrees Fahrenheit. There is a linen closet with an adequate supply of fresh linens ready to use. No obstructions and or tripping hazards found throughout the facility. Facility has landline, LPA checked it was operational. There is a television, cabinet for activities, books and art supplies available for clients’ use. Bathroom: There are two (2) 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 11:05am to be 111.7 degrees Fahrenheit. LPA also observed required signs on the bathroom walls and non-skid mats inside the showers. Garage: LPA observed the garage is attached to the facility and is currently being used as storage for PPE supplies and for emergency water. Laundry Room: Functioning washer and dryer located adjacent to kitchen area inside the locked closet. The laundry detergents and other chemical supplies are also locked inside the closet and inaccessible to clients in care. Backyard: LPA observed sufficient yard space and fenced backyard. Appropriately covered shaded area available for clients to rest. LPA discussed the importance of maintaining the care and supervision to meet the needs of clients. Exit doors were unlocked and free of obstructions. There is no body of water in the property. Continue on LIC809-C Staff/Client File review: Facility records are kept inside the locked cabinets located between the kitchen and dining areas. Between 11:15am -12:00pm LPA conducted records review of four (4) staff files and five (5) residents’ records. Files were complete and updated. Medications : At approximately 12:05pm. 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 kitchen cabinet and inaccessible to clients in care. Complete First-aid kit is also located in the same kitchen cabinet, new manual for first aid kit was also available. No potentially dangerous items were found in the facility. The facility operates with two (2) shifts and has two / three staff members for each shift. All residents were present during the visit, LPA attempted to interview all residents and the Caregivers. Facility plan/sketch is posted on the entrance wall along with other posting requirements. LPA collected LIC500, LIC9020, and the Liability Insurance Certificate copy The Administrator's certificate - Exp date is 2/13/2027. Liability Insurance - Expires 07/22/2026. LPA informed the Administrator that License Annual Fee is past due: Due date was 7/16/25 for the amount $495.00. LPA also provided the PIN 667713 for online payment. No citations issued during today's visit. Exit interview conducted. Copy of this report provided.