Routine inspection·July 18, 2024

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Required Annual Inspection. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Caregiver Rowena Manalili, Co-Administrator Mark Cruz and House Manager Justin Cruz arrived shortly after. According to the facility’s license, the facility has a maximum capacity of six residents, of whom all may be non-ambulatory. LPA toured the interior and exterior of the facility and inspected each room. The kitchen had dirty floors, sticky and disorderly cabinets. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. One resident bedroom had a stand alone air conditioner that was collecting condensation water into a bucket, such bucket was almost full and sitting in residents room. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas. No pool or body of water was present. Water temperature was measured at 105.3 degrees F in the kitchen and 89 degrees F in resident bathroom. Per Mark, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguishers were present. First aid kit was complete. Resident records reviewed had required documentation. Needs and Services plans were not signed by resident or responsible party. Hospice resident full bed rail orders were observed. Staff records reviewed contained required documentation. One technical violations was issued for unsigned Needs and Services Plans, three additional deficiencies were cited for physical plant. An exit interview was conducted with Co-Administrator, to whom a copy of this report, LIC9099D (x2) and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.