Routine inspection·April 9, 2026

At 12:34 am on 04/09/2026, Licensing Program Analyst (LPA) Rankin arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Administrator Michelle Tantingco announced who they are and the reason for the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: The facility is a 7 bedroom and 6-bathroom. The facility occupies 6 residents and employs 4 staff of which one is the Administrator. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. LPA noted that all resident bedrooms had required furnishings and bedding by regulations requirements. The facility has smoke and carbon monoxide detectors. Carbon Monoxide and smoke alarms were tested and working properly at time of visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The showers have non-skid mats/flooring. Toilet, hand washing and bathing facilities are operational and secure grab bars are present. The pathways are clear of any obstructions. Disinfectants, cleaning solutions and poisons are inaccessible to residents. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard for client use with furniture and plenty of shade. The backyard has 2 locked sheds to store extra items, including yard tools. Operational Requirements: The facility has a current plan of operation on file. The Facility is operating in compliance with the granted fire clearance based on the facility sketch. The facility has current liability insurance and expires on 03/04/2027. The facility is approved for a capacity of 6 non-Ambulatory and approved for hospice waiver of 6. Continued on 809-C Staffing, Personnel Records & Training: LPA reviewed 4 staff files. Administrator certificate expires 08/30/2026. Staff files reviewed had all required documentation including current 1st Aid and CPR certificates. All annual training has been completed for the last 12 months. Resident Records & Incident Reports: All 6 files were reviewed for required documentation including updated Medical Assessments, and Appraisal Needs and Services plans (ANS). All records were complete. Incidental Medical & Dental : The facility has a medication cabinet that is kept locked. Facility provides or assists in providing transportation to medical and dental appointments when needed. A sampling of medications records were reviewed. Facility has Centrally Stored Medication Destruction Record (CSMDR) on all residents, and the documentation is up to date. PRN Authorization documents are on file. No medications labels were altered, no expired medications, and medications were stored in original containers. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7 day non-perishables to meet the food service requirement. All food is covered and stored appropriately. Fresh fruit and vegetables were noted by LPA. Food, snacks and drinks are available when the residents want them. Cleaning solutions and equipment are stored separately from food supplies. Kitchen areas are kept clean. Disaster Preparedness : The current emergency disaster forms were posted. The facility conducts disaster drills quarterly, last one done on 1/20/26. The fire extinguishers were charged and last inspected on 1/22/26. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or inaccessible to residents in care. The facility does not have delayed egress. The facility does have 1 hospice residents in care. Hospice services records are kept on file. The facility gates are self-latching and self-closing. The backyard is completely fenced. Exit interview conducted, copy of report printed for Administrator.