Routine inspection·May 28, 2025

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by caregiver staff and explained the reason for the visit. Administrator (AD) Arvin Bumanglag arrived shortly to assist with the visit. Facility is licensed for six non-ambulatory residents with a hospice waiver for four. Currently there are six residents, of which three are on hospice during today's visit. LPA Tea reviewed six resident files and three staff files. Resident files and staff files for the most part contained required documentation except for one resident was missing the Personal Rights form. Administrator will have the resident’s responsible party sign the form as soon as possible. Administrator certificate expires on December, 10 2026. LPA Tea along with AD Bumanglag toured the facility at 9:38 AM. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of six resident bedrooms, three bathrooms, living room, dining room, staff office area, kitchen and an attached garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 113.5 F degrees and 116.6 F degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, and doorways were free of obstructions. First aid kit had all the required elements including dressing, bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Annual inspection continued on LIC809-C Perishable and non-perishable food supply were checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. LPA also observed toxin substances to be secured and inaccessible to residents in the garage. Fire extinguishers throughout the facility are fully charged. The facility’s last disaster drill was conducted in February 13, 2025. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there are two exit gates on both sides of the house that are self-latching and operational. The backyard has a shaded table for clients to sit. LPA observed emergency supplies, food and water in the garage. Activities are based on resident’s personal preference or health condition. Facility provides activities like light exercises like walking outside and chair exercises. They also provide musical therapy for the residents. At the time of the visit LPA observed residents having breakfast and watching television. LPA then reviewed medication storage and administration. Medications are stored in locked cabineta in the kitchen area. Medications are being administered per physician order. LPA interviewed clients regarding their quality of care and spoke to staff present regarding care provided. Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the facility and a copy of this report LIC809, 809-C, LIC858, LIC859, LIC9102 was read and provided to the facility.