Follow-up·February 25, 2022

Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct a case management visit. LPA's temperature was taken prior to being allowed entry into the facility. LPA confirmed with staff that zero residents or staff have displayed signs or symptoms of COVID-19 in the last 10 days. LPA explained the purpose of the visit and met with staff on shift. LPA Valerio interview 1 staff. Staff stated the licensee is Angelita Dayoan and the Administrator is Karl Padua. No notices of change of ownership has been given to staff or residents. Administrator Certificate #6057871740 Expiration Date: 11/16/2022. According to facility records, Karl was designated as the acting administrator on 08/20/2021. LPA interacted with Resident 1 (R1) during today's visit. R1 stated R1 has lived at the facility for one year and enjoys living here. R1 was observed watching television, eating R1's favorite crackers, and interacting with the staff. Residents 2 - 5 were in their room taking a nap. LPA observed the following documents posted in the common area for public review: LIC 500 Personnel Roster, LIC 309 Administrative Organization, COVID -19 Informational, LIC 308 Designated Responsibility of Facility, most recent licensing report, personal rights, most recent PIN from CCLD, and Emergency Plan Based on observations and interviews, no deficiencies were observed. Exit interview held with facility staff and a copy of the report was left at the facility.