Routine inspection·August 14, 2025

On 8/6/2025, Licensing Program Analyst (LPA) Cynthia Tamayo arrived unannounced to conduct a Required - 1 Year visit. LPA met with administrator, Glenda Molinyawe and explained the purpose of the visit. Administrator Isagani Sisaya is out on vacation. Current LIC 308 designated S1 as Designated Facility Responsible person. Administrator Certificate # for Isagani Sisayan is 7002475740 and expires 10/23/2025. Administrator Certificate # for Glenda Molinyawe is 6052178740. The facility is approved for five (5) ambulatory residents (Age range 60 and over) in which five (5) may be non-ambulatory and one (1) bedridden in bedroom #1 only. Hospice waiver for 2 has been granted. There is currently one resident on hospice. LPA toured the physical plant was conducted with S2 to ensure residents’ health and safety and the facility is in compliance with Title 22 regulations. The following was observed: KITCHEN: Appliances and fixtures were clean and functional. The facility had ample supply of perishable and non-perishable food. Meals are prepared by the Staff. Refrigerator temperature was at 45 degrees F and freezer temperature was at 0 degrees F. Knives and other sharps are locked inaccessible in a drawer. Kitchen and house cleaning supplies are stored in a locked cabinet located under the sink. COMMON AREAS: Common areas include the Living Room and Dining Room. All furniture was observed to be clean and in good condition with enough seating for six residents . There was space to accommodate both indoor and outdoor activities. LPA noted an Activity Calendar and activity storage in the entrance bulletin board. One (1) fire extinguisher was observed throughout the common area and was last serviced on 09/24/2025. Combination smoke detectors and carbon monoxide detectors were working and operational. Continued on 809-C EXTERIOR: Exterior passageways were clean and clear of any obstructions. There is a covered patio area for client and visitor use with furniture observed to be in good condition. Clients are supervised at all times when they are outside. There is one (1) gates with a self-latching mechanism for persons to exit the backyard in emergencies. BEDROOMS: LPA inspected facility bedrooms. The facility has six(6) total resident. All bedrooms were observed to contain furniture, bedding and linens within regulation. Extra linens are stored in the hallway cabinet. Client bedrooms had no visible hazards observed. BATHROOMS: All bathrooms were observed to be clean and sanitary, and supplied with paper and hygiene products. Water temperature was tested and both measured at 114.6 degrees F. MEDICATION REVIEW: LPA reviewed medications which are centrally stored in a locked cabinet in the hallway. All medications were stored and administered in compliance with regulation. RECORD REVIEW: LPA reviewed six (6) resident file records. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. Resident files reviewed contained all required documents. LPA discussed the following with S1: (1) The requirement to do a re-appraisal and/or updated physicians report (LIC 602) when there is a change of condition for residents, such as hospice status. (2) Also, hospice status does not automatically constitute bedridden status, appropriate fire clearance would be required for changing a room to bedridden status. LPA reviewed three (3) staff records during today's visit. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All staff records reviewed were in compliance at the time of the visit. RESIDENT INTERVIEWS: LPA Tamayo interviewed two residents who were able to respond verbally, residents voiced no concerns with their quality of care, and said they receive all assistance when needed. continued on 809-C INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility's infection control plan as well as the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are within regulation. Both documents were observed to be complete and recently updated. Personal Protection Equipment (PPE) and extra emergency supplies, including emergency food and water, are stored in the garage. The following documents will be email to LPA by 8/21/2025 end of day (5:00 PM): (1) LIC 610 Current Emergency Disaster Plan (2) Proof of Current Liability Insurance (3) Surety Bond (if applicable) (4) LIC 309 Administrator Organization As a result of this annual visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted with Glenda Molinyawe, and a copy of these LIC 809 reports were provided to the facility.