Routine inspection·July 29, 2025

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Caregiver Marilou Delapena. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, one (1) of which may be bedridden. Bedridden may reside in bedrooms 1, 4, or 5. The facility is approved for four (4) hospice waivers. During today’s inspection there were five (5) residents in care. Licensee Ferdinand Agpaoa arrived later during the visit. LPA accompanied by Caregiver Delapena and Licensee Agpaoa, toured the interior and exterior of the facility and inspected each room. Licensee The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant: one common bathroom sink was 107.7F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment (PPE). LPA observed staff to utilize PPE and perform hand hygiene when assisting residents. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. Knives were locked and inaccessible to residents in care. [Continued on LIC 809-C] [Continued from LIC 809] No toxic chemicals or poisons were accessible to clients.  Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Licensee Agpaoa, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months. Last emergency drill conduced was on June 30th, 2025 for the topics of fire evacuations and fire extinguisher handling. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed one (1) staff and zero (0) clients, and interviews did not reveal any licensing or regulatory concerns. LPA reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. During the visit, LPA observed residents to be attended to quickly and with respect. Additionally, LPA noted that the facility has an outsourced activities partner to provide personalized supplemental activities on a weekly basis. No deficiencies were cited during the inspection. An exit interview was conducted with Licensee Agpaoa to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.