Routine inspection·March 24, 2025

On March 24, 2025, Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced Required Annual Inspection and met with Vergal Agatep, Administrator Facility is licensed to serve six(6) non-ambulatory/ambulatory clients ages 60 and above. Facility may retain three (3)hospice clients. Currently, facility census is 0 (As of 12/15/24) annual fees are current, liability insurance is active. The facility is a single-story structure located in a residential neighborhood. Facility consists of the following: four (4) client rooms, one (1) staff bedroom, one (1) common bathroom, two (2) private bathrooms and one (1) private half bathroom in room five (5), a living area, dining area, kitchen, outside covered patio area and an attached garage that houses a washer and dryer, an additional refrigerator, canned goods and also serves as storage space. All passageways, walkways, driveways, steps and patios are free from obstructions. LPA and Administrator toured facility inside and out. LPA observed no bodies of water on the premises. Bedrooms LPA inspected all (4) bedrooms All bedrooms were observed to have the required furniture including beds, dressers, night stands with lamps, chairs, and ample storage space for personal belongings. All bedrooms were observed to be clean, in good repair, and have ample lighting. Page 1 of 3 Bathrooms LPA inspected the facility bathrooms. In the resident’s bathroom the toilet, faucets, and shower were fully operational. All safety handrails were securely fastened. LPA observed the showers to be clean and free of mold or mildew. The shower had a nonskid material in bottom and shower chair. The water temperature measured 110 degrees Fahrenheit. All bathrooms were observed to be clean, in good repair and within Title 22 regulations. Linens & Hygiene LPA observed all beds to have the required linens including mattress cover, fitted sheets, blanket, comforter, and pillow. LPA observed an ample supply of linens, towels, and blankets in hall closet. Kitchen LPA inspected the kitchen and observed all appliances to be in good working repair, including stove/oven, microwave, refrigerator. LPA observed an ample supply of cutlery, pots, pans, and bowls to be in good repair. LPA observed knives and additional sharps to be secured in locked and inaccessible to residents. LPA observed a 2-day supply of perishable foods and a 7-day supply of nonperishable foods. Safety LPA observed and tested smoke/carbon monoxide combo detectors to be fully operable. LPA observed (3) fully charged fire extinguishers that was last serviced on 1/8/25 The last emergency drill was conducted on 5/3/24 LPA inspected the First Aid kit and found it contained an ample supply of required items: Scissors, tweezers, gauze, disinfectant wipes, band aids. LPA observed all exits to be clear and easily accessible. All toxins locked and inaccessible to residents in care. Medications: There are no medications to observe because there are currently no residents in facility at this time (as of 12/2024). LPA did observe where medications are stored which is locked and inaccessible to the residents. Page 2 of 3 Files LPA reviewed ( 2 ) former resident files and found that (2 ) out of (2) contained all the necessary documentation. LPA reviewed (2) staff files and found that (2 ) out of (2 ) contained the required documentation, certification, and training. Liability Insurance expires on 07/1/2025. Outside area: During visit LPA observed the outside grounds (front and back) to be free of clutter, debris, and passage ways were free of obstruction. There were no deficiencies cited during today’s visit. Exit interview conducted and copy of report provided to Vergal Agatep, Administrator. Page 3 of 3