Routine inspection·August 7, 2025

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Dominador "Pong" Dacanay. Licensee Monica Siharath arrived during the visit. The facility is licensed for a maximum capacity of 6 non-ambulatory residents and has a waiver for 3 hospice residents. During today’s visit, the facility had a census of 6 residents, 5 of which were non-ambulatory. During today’s visit, LPA toured the facility and inspected each room of the facility, including resident and staff bedrooms, bathrooms for resident and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed on the premises. LPA did not observe any aspects of delayed egress or secured perimeter. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured at 105.2 and 105.8 degrees Fahrenheit in bathrooms for resident use. The facility’s internal temperature was measured at 77 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. According to Monica Siharath, no firearms or weapons are stored on the premises. LPA also observed locked storage for resident medications and resident and staff files. Resident medications are stored in their original container and labelled. LPA observed a minimum of a 2-day supply of perishable food and a 7-day supply of non-perishable food present at the facility. The facility refrigerator was kept at 32 degrees Fahrenheit, and the facility freezer was kept at -6 degrees Fahrenheit. LPA observed linens and hygiene products provided to the residents that are in good repair and sufficient to meet their needs. Continued on LIC809-C page… Staff present at the facility during the time of the inspection had a criminal background clearance, were associated to the facility, and had a first aid certificate. LPA reviewed multiple resident and staff records. Resident records contained a signed admission agreement, initial medical assessment, updated annual reappraisal, documents regarding safeguarding personal property, and personal rights. Each staff file was complete and contained a personnel record, first aid certificate, fingerprint clearance and association, and a health screening. LPA spoke with staff and residents present at the facility during the time of the inspection and those interviews did not reveal any licensing or regulatory concerns. LPA provided Licensee with consultation and guidance regarding the regulation changes that became effective 1/1/2025. LPA was away from the facility for approximately one hour between 12:00pm and 1:00pm. No deficiencies were cited on today’s date. An exit interview was conducted with Licensee Monica Siharath, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).