Routine inspection·May 19, 2025

On 05/19/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required 1 year inspection. LPA met with caregiver Emielita Capistrano and explained the purpose of today's visit. Currently there are 5 residents present and 2 caregivers during today's inspection visit. The facility is licensed for age range 60 years and over. All are approved to be non-ambulatory. Hospice waiver for 5 residents. Currently there are 2 residents on hospice per staff interviewed. Rooms 3 and 4 are approved to be for bedridden residents. The facility ambient temperature is comfortable. The required postings are in place observed in main dining area adjacent to the kitchen. Water temperature is tested in the common hallway full bathroom measuring as 120F. The facility has two full bathrooms and both were tested at 120F. Both are equipped with grab bars and non-skid mats. Cleaning supplies are observed to be locked in the garage primarily and a few cleaning supplies are locked below the kitchen sink. Facility knives are observed to be locked in a kitchen cabinet adjacent to the refrigerator. Facility food supplies are observed to be in place with 2 day fresh food supply and canned goods fulfilling the 7 day emergency food supply. Laundry area is observed in the garage as well and is fully operational. Additional cleaning supplies are observed to be locked in a large storage closet in the garage. A tour of the outside of the facility is conducted. Emergency routes are free and clear of any obstructions. There is a locked storage shed in the backyard that contains garden supplies and furniture. Smoke detectors and carbon monoxide detectors are located through out the facility. LPA observed 2 fire extinguishers are observed in the facility. Both with inspection dates of 05/15/2025. Both are charged and ready for use. Facility conducts emergency drill quarterly. The last drill that was conducted is logged 05/01/2024. Linens are in place for resident in care as observed in a hallway closet near Room 1. Continued on next page... Page 2 LPA observed all resident rooms and observed that they contain the required furniture and lighting as outlined in Title 22. Medications are current, locked, and logged appropriately. First aid kit is present. Hygiene supplies are in place. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed as current. LPA reviewed 4 resident files and 3 staff files on this day. All files reviewed are current. Administrator certificate for licensee/administrator May E. Dela Rueda is observed as expired on 11/16/2024 and Emelita Capistrano is current expiring 09/06/2025. The following updated items are to be received by 05/26/2025 : • Copy of administrator certificates • Copy of facility's liability insurance • LIC308 Designation of responsible staff person • LIC402 Surety bond and Copy of active bond • LIC610E Emergency Disaster Plan • LIC500 Staff Schedule Report is reviewed with Emelita Capistrano. A copy of this report is provided to the facility. No deficiencies cited as a result of today's inspection visit.