Pre-licensing visit·June 4, 2025

Licensing Program Analyst (LPA) Debbie Correia conducted an announced Pre-Licensing/Component III inspection at the facility. LPA was greeted at the front door by Applicant Chona Simsuangco, identified herself and was granted entry. Administrator Leonardo Simsuangco was also present during the inspection. The facility received fire clearance on February 26, 2025. The facility was approved for a capacity of six (6) residents (ages 60 and above), all of which can be non-ambulatory and one (1) bed-ridden to be housed in bedroom #3. LPA Correia, accompanied by Applicant Chona and Leonardo Simsuangco, conducted an overall inspection/tour of the facility inside and out, and a facility records review. During the facility tour LPA Correia observed the facility is equipped with fire extinguishers, smoke alarms and carbon monoxide detectors that were all operational and up to date. LPA also observed emergency lighting, first aid kit and manual, and hallway night-lights. The facility bedrooms for residents in care are furnished appropriately, including padded mattress covers, dressers and closet space, and lighting. Bathrooms are equipped with grab-bars, non-skid flooring for showering. [Continued on LIC809C] Locked cabinets were present for medications, toxins, cleaning supplies, and records. Taps accessible to residents in care measured within regulation at 109.6 and 111.4. The facilities ambient temperature was 69 degrees Fahrenheit. The facility was observed to be sanitary and in good repair. No obstruction of pathways or bodies of water were observed on the premises. There is facility has extra linens and toiletries, and Personal Protective Equipment(PPE). LPA also observed the required postings, ample room for activities and visitation, and an outdoor shaded area. The facility also has a prepared monthly menu for meals, and activities schedule. LPA also observed the required postings, ample room for activities and visitation, and an outdoor shaded area. The facility also has a prepared monthly menu for meals, and activities schedule. Per applicants there will be no firearms or ammunition kept on the premises. The Pre-Licensing and Component III was completed on today’s date. The facility is ready for licensure pending management approval. An exit interview was conducted with Applicant Chona Simsuangco. A copy of this report along with the licensee Rights (LIC 9058 01/16) will be provided at the conclusion of the visit. Signature on this form confirms receipt of the reports.