Routine inspection·April 14, 2023

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Licensee (LNS) Ven Ignacio. LPA checked 5 resident record files (R1 - R5) and 4 staff record files (S1 - S4). 5 residents (R1 - R5) and 2 staff (S3 - S4) were interviewed. Personnel Records were observed incomplete. LPA toured the facility inside out with LNS. Facility license, Administrator Certificate, were observed posted at the facility. Living room, family room, kitchen, dinning room and two and half restrooms were inspected. Six single resident bedrooms which including 3 bedrooms with bathroom inside, and laundry room were inspected. One staff live-in rooms are in facility. Non-skid mats and grab bars were observed in bathrooms. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet knives closet was observed locked. Cleaning product closet and knives closet in the kitchen were observed unlocked. Room temperature was at 72 degree F, and hot water temperature was at 107 degree F in facility. Fire extinguisher was serviced on 04/28/2023. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors and fire alarm system were tested by LNS, and were working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways. Citation were noted today. See LIC809-D. Exit interview was conducted with LNS. This report was provided to LNS for signature. A copy of the report was provided to LNS. Appeal Rights form was provided to LNS.