Post-licensing visit·October 9, 2025

On 10/09/2025, Licensing Program Analyst (LPA) Pang Lee arrived at this facility unannounced to conduct a post-licensing inspection. LPA Lee arrived met with administrator Tevita Kaloulasulasu and explained the purpose of the visit. Administrator assisted with today’s visit. There are currently six (6) residents living at the facility. LPA conducted a tour of the physical plant, both inside and outside, alongside Administrator Kaloulasulasu to assess any health and safety concerns. LPA inspected the common areas, kitchen, dining area, resident bedrooms and bathrooms, laundry room, and outdoor courtyards to ensure compliance with Title 22 regulations. The facility was observed to be clean, free of odors, and in good repair. Resident bedrooms were appropriately furnished, with adequate bedding and lighting. The hot water temperature was measured at 116.3°F. The indoor temperature was 71°F, which falls within the required range of 68°F to 85°F. LPA observed the facility maintains at least one week’s supply of nonperishable food and two days’ supply of perishable food. Additionally, a Walmart delivery consisting of 17 bags of groceries and household supplies was observed. Fresh fruit including pineapples, bananas, oranges, and both green and red apples were available on the dining table for residents. LPA also observed a designated wooden mailbox for incoming resident mail, along with a mail log tracking the date, time, and receipt of mail. The centrally stored medication area was locked and inaccessible to residents. CONTINUED LIC 809-C Fire extinguishers and first aid kits were up to date. Smoke and carbon monoxide detectors were present and in good working conditions. Required postings were displayed at the facility entrance, including: · “See Something, Say Something” poster · Ombudsmen contact information · Resident Personal Rights · Evacuation Routes · Facility License · Administrator Certificate During the visit, LPA observed Staff 1 (S1) leave a resident’s medication unattended on the kitchen counter. Administrator Kaloulasulasu immediately retrieved the medication and properly secured it. LPA reviewed files for all six (6) residents and two (2) staff members. All records were complete and contained the required documentation. Staff records confirmed that all individuals requiring caregiver background checks were fingerprint cleared and properly associated with the facility. As a result of this post-licensing the facility is in compliance with Title 22 Regulation. An exit interview was conducted with Administrator Kaloulasulasu and a copy of these LIC 809 reports along with LIC 9102 Technical Violation were provided to the facility.