Routine inspection·July 22, 2025

At approximately 3:00 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and was greeted by staff. Xiomara Robles, Licensee was contacted via telephone and arrived at facility at approximately 3:15 PM. Archebal A. Balaoy, Administrator/Licensee arrived at approximately 3:30 PM. Facility is a Residential Care Facility for the Elderly (RCFE) with one (1) resident in care. Facility has a Dementia Care Plan, is approved for all non-ambulatory residents. At approximately 3:20 PM, LPA initiated a tour of the facility with Licensee and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. LPA observed egress devices activated on all facility doors. Licensee agrees to ensure water temperatures test within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a shaded seating area in the backyard with outdoor space for activities. LPA observed resident watching TV in the common area of the facility during inspection. Facility has coloring supplies and games for residents. Facility has internet service and agrees to obtain an internet access device designated for resident use. The telephone was tested and was operational during inspection. Smoke and carbon monoxide detectors were tested and operational during inspection. Fire extinguisher was observed fully charged and was last inspected 07/2025. Continued on LIC809-C... Continued from LIC809C... Emergency Disaster Plan was reviewed and updated 05/2024. Facility conducts monthly disaster drills with the most recent drill conducted 06/2025. Facility assists with coordinating medical and dental appointments as well as transportation to and from appointments when residents have the need. Facility does not manage P&I cash resources for residents. LPA will return at a later date to complete staff, client, and medication file review. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit : LIC610E - Emergency Disaster Plan Proof of Liability Insurance Proof of control of property - Current Lease Agreement Exit interview conducted with Licensee whose signature on form confirms receipt of documents.