Routine inspection·November 4, 2025

On November 4, 2025, Licensing Program Analysts (LPAs) Brandon Lopez and Garlli Tat made an unannounced visit to the facility to conduct the required annual inspection. LPA were greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Licensees (LIs) Allen Medina and Keak Vongphakdy were notified via telephone and later arrived to assist with the inspection. LPAs observed that Administrator Bhonalyn Ladia has a valid Administrator certificate which expires on January 29, 2027. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for six. The facility is a single story home with five resident bedrooms, one of which is shared, two staff bedrooms, five resident bathrooms, a living room, a dining room, a kitchen, a staff office, and a detached two car garage. LPAs, accompanied by the LIs, conducted a tour of the interior portions of the facility. On today's visit, LPAs observed six residents in care and two care giving staff present. LPAs observed residents relaxing in the living room and in their respective bedrooms. LPAs observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPAs inspected the five resident bedrooms and observed them to be free of hazards. LPAs observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPAs observed resident beds to have clean linens and blankets. LPAs observed additional linens to be stored in a hallway closet. LPAs inspected the five resident bathrooms and observed them to be clean. LPAs observed resident bathrooms to be equipped with grab bars and nonskid floor mats. Faucets and toilets were operational. Hot water temperature measured between 111.7 and 113.3 degrees Fahrenheit. LPAs observed the two staff bedrooms to be clear of any hazards. LPAs observed the facility has a two day perishable and a seven day non-perishable food supply on hand in the kitchen. CONTINUED ON 809-C LPAs observed kitchen appliances to be clean and operational. The five burner gas stove lights unassisted. LPAs observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a locked cabinet in the kitchen pantry. LPAs observed a First Aid Kit to be stored in the pantry and it had all the required components. LPAs observed the facility has a three day emergency food and water supply stored in the pantry. LPAs observed fire extinguishers to be mounted on the walls in the kitchen pantry and in the resident hallway. Fire extinguishers were observed to be charged and serviced as of April 9, 2025. LPAs tested the wired smoke detectors and the individual carbon monoxide detectors which tested operational. LPAs observed the facility conducted their last emergency disaster drill on August 11, 2025. LPAs observed the centrally stored medication to be kept in the locked staff office. LPAs observed all utilities to be operational at time of visit. LPAs, accompanied by the LIs, conducted a tour of the exterior portions of the facility. LPAs observed the exterior to be free of obstructions and hazards. LPAs observed a shaded outdoor seating area with furniture for resident use. LPAs observed the perimeter gates of the facility to be self latching and can be opened in an evacuation. LPAs inspected the detached two car garage located in the front yard. LPAs observed the two car garage to be used for storage and kept locked for resident safety. There are no bodies of water on the premises. LPAs reviewed the six resident files. LPAs observed there was no Reappraisal on file for Resident #3 (R3). LPAs also observed that the Reappraisals on file for Resident #2 (R2), Resident #4 (R4), and Resident #5 (R5) were outdated. LPAs reviewed residents' medication and medication records. LPAs reviewed four staff files. All staff are background cleared and associated to the facility. LPAs observed the facility does not currently have liability insurance. Based on the observations made during today's visit, deficiencies are being cited on the attached LIC809-D. LPAs also advised the LIs of the facility's outstanding balance for their annual fees. LPAs also requested the following documents to be submitted to them via email by close of business day November 14, 2025: Payroll records for all sixteen licensed facilities for August, September, and October 2025. Utility bills for all sixteen licensed facilities for August, September, and October 2025. Food receipts for all sixteen licensed facilities for August, September, and October 2025. Rent payments for all sixteen licensed facilities for August, September, and October 2025. An exit interview was conducted with Licensees Allen Medina and Keak Vongphakdy. A copy of the report and Appeal Rights were provided.