Routine inspection·July 25, 2025

On July 25, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Administrator (AD) Ma Dinah Dela Cruz was notified via telephone and later arrived to assist with the inspection. LPA observed Ma Dinah Dela Cruz submitted an Administrator renewal application to the Administrator Certification Bureau (ACB) on May 5, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for two. The facility is a single story home with three resident bedrooms, two staff bedroom, three bathrooms, a living room, a dining room, a kitchen, and an unattached two car garage. LPA, accompanied by the AD, conducted a tour of the interior portions of the facility. On today's visit, LPA observed two resident in care and two staff present. LPA observed residents relaxing in their respective bedrooms. LPA observed the See Something, Say Something poster, (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected all three resident bedrooms and observed them to be free of hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA inspected the two shared resident bathrooms and observed them to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 118.9 to 119.6 degrees Fahrenheit. LPA observed the two staff bedroom to be kept locked and inaccessible to residents in care. LPA observed the facility has a two day perishable and a seven day non-perishable food supply on hand. CONTINUED ON LIC809-C LPA observed the facility has a three day emergency food and water supply stored in the kitchen. LPA observed kitchen appliances to be clean and operational. LPA observed the five burner gas stove lights unassisted. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a locked kitchen cabinet under the sink. LPA observed a fire extinguisher to be mounted on the wall in the kitchen and it was observed to be charged and serviced on July 7, 2025. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the centrally stored medication to be kept in a locked cabinet located in the kitchen. LPA observed the facility has a first aid kit mounted on the wall in the resident hallway and it had all the required components. LPA, accompanied by the AD, conducted a tour of the exterior portion of the facility. LPA observed a shaded outdoor seating area with furniture for resident use. LPA observed the passageways leading to the front yard had obstructions which included tree branches/leaves and other items. LPA observed the unattached two car garage to be used for storage. LPA observed the perimeter gates of the facility to be self latching and can be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed both resident files. All the required documentation were present and current in the resident file reviewed. LPA reviewed the residents' medication and medication records. LPA reviewed three staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, a deficiency is being cited on the attached LIC809-D. An exit interview was conducted with Administrator (AD) Ma Dinah Dela Cruz. A copy of the report and Appeal Rights were provided.