Routine inspection·September 5, 2025

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation using the CARE Inspection Tool. LPA was greeted and granted entry by Caregiver Tedjo Pranoto followed by Licensee/Administrator (Admin) Aurica Bintintan after explaining the purpose of the visit. The facility is a single story structure located in a residential neighborhood. Facility operates within the conditions and limitations specified on the license. LPA observed two caregivers on duty providing care to six residents of which one is under hospice care. The Administrator's Certificate for Aurica Bintintan expires on March 25, 2026. The following was observed during the inspection: There are five resident bedrooms and five resident bathrooms. There are two additional staff bedrooms and one private staff bathroom in the master room. All common areas were inspected including the attached two car garage. The residents' bedrooms were appropriately furnished. Beds and bedding supplies were in good condition, adequate lighting was provided, sufficient storage space for each residents' personal belongings were observed. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 115.5, 117.3, 117.6, 118.7, and 117.5 degrees Fahrenheit in the resident bathrooms. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food. LPA toured the exterior portion of the facility. LPA observed the outdoor passageway is free of obstructions. The sheds which holds continence supplies, medical equipment, and cleaning solutions in the passageway is inaccessible to the residents. The two exit gates were operational. LPA observed sufficient seating and shading. The fire extinguisher was purchased on September 5, 2025 per review of the receipt. The auditory devices and smoke/carbon monoxide detectors were tested and operational except one auditory device in the room of Resident #3 (R3). LPA observed the emergency disaster supplies including food/water in the garage. Emergency evacuation drills are being conducted quarterly in review of one out of two personnel files with the last date on July 16, 2025. LPA observed the required 'See Something, Say Something' (PUB475) poster in the correct size posted in the entry way. LPA conducted interviews, and audited six residents' files and two personnel files in which no discrepancies were noted with the resident files. However, the Health Screening Report (LIC503) was not available for Staff #2 (S2). Medications were audited for six residents. Discrepancies noted. Based on the observations made during today's visit, a deficiency is being cited and Advisory Notes are being issued. An exit interview was conducted with Licensee/Administrator Aurica Bintintan, and a copy of this report including the LIC811, LIC9102s, and the appeal rights were provided at the end of the visit.