Routine inspection·September 2, 2025

On September 2, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Administrator (AD) Arvinh Bumanglag arrived shortly after and was present to assist with the facility inspection on today's date. The facility is licensed for six (6) non-ambulatory residents of which one (1) may be bedridden with approved hospice waiver for six (6) residents. Currently, there are six (6) Hospice residents present during today’s visit. This is a single story home with two attached garages facility. The facility has seven bedrooms (one staff room & six private resident rooms), five bathrooms, kitchen, dining room and common area room used for activities. At around 8:30AM, LPA conducted a tour of the physical plant accompanied by staff, and the following was observed: All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage area for the client's personal belongings was observed. Bed linens, and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 119.2 degrees F. A comfortable temperature of 73 degrees F. was maintained in the facility. CONTINUED ON 809C LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies and sharps objects were stored and not accessible to residents. The kitchen was inspected, home has operational stove/ oven, fridge and sufficient two day perishables and seven day non-perishable food was maintained adequately. Facility has supply of emergency food and water. Facility has three fire extinguishers which were fully charged. A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, and sanitizing stations in common areas and restrooms. LPA observed the facility has a supply of Personal Protective Equipment (PPE). Facility has mandated inspection control posters posted. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on 8/5/2025. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. The facility has current liability insurance on file effective 9/1/2025 – 9/1/2026. A review of six residents (R1-R6) service files and two staff (S1-S2) personnel files revealed to be complete. The facility has the current administrator's certification on file for Arvin Bumanglag # 7002119740 - Expiration 12/10/2026. Administrator certification confirmed on CCLD Administration Certification List. No deficiencies during this inspection visit. An exit interview was conducted with Administrator Arvin Bumanglag, and a copy of the report was provided.