Routine inspection·June 6, 2025

At approximately 12:40 PM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by caregiver. Licensees Danilo Sy and Thelma Sy were called and arrived at approximately 1:15 PM. Facility is a Residential Care Facility for the Elderly (RCFE) with two (2) residents in care. Facility has a Dementia Care Plan and is approved for all non-ambulatory residents. Residents were at day program during this visit and returned as LPA was leaving. At approximately 1:20 PM, LPA initiated a tour of the facility with Licensees and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguisher was observed charged and last inspected 6/24. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 111.7 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. There is a shaded seating area in the backyard with outdoor space for activities. Facility has an internet access devise and internet available to clients in care. Facility conducts quarterly disaster drills, and the most recent drill was conducted 3/25. Continued 809C... Continued from 809... LPA observed facility's infection control plan and emergency disaster plan. LPA informed Licensees of the need to sign and review disaster plan every year regardless if there has been no changes. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 2:00 PM LPA conducted review of two (2) staff records. All required documentation present. At approximately 2:20 PM LPA conducted a review of two (2) resident records. All required documentation present. At approximately 2:30 PM LPA and Licensees conducted check of P&I. All records present and cash is reconciled. At approximately 2:40 PM LPA and Licensees conducted a spot check of medication and medication records. Medication is centrally stored and locked. Thelma Sy Administrator Certificate 7006452740 expires 10/25/2026. All fees are current as of this time. Updated copies of the following documents shall be submitted to CCL within 30 days of this visit : LIC610E - Emergency Disaster Plan Updated copies of the following documents were gathered during this visit : Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC402 - Surety Bond No deficiencies cited. Exit interview conducted with Licensee, whose signature on form confirms receipt.