Routine inspection·June 30, 2025

At approximately 9:30 AM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by staff. Administrator Rashmika Mahawar was called and gave permission for Manager Theresa Ilagan to sign and receive report. Facility is a Residential Care Facility for the Elderly (RCFE) with twelve (12) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for ten (10), with two (2) Hospice residents currently in care, and is approved for all non-ambulatory residents and ten (10) bedridden. At approximately 10:30 AM, LPA initiated a tour of the facility with Manager and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 1/25. Smoke and Carbon Monoxide detectors are hardwired and serviced by fire department alongside the fire extinguishers. Water temperatures in spot check of resident bathrooms measured 110.8-,114-, and 115.3 degrees F and communal bathroom sink measured 113.7 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. Facility activity room was stocked with games, books, and a piano. Throughout visit, LPA observed activities director conducting various group and one-on-one activities. Facility phone was tested and operational during today's inspection. Continued 809C... Continued from 809... Facility conducts quarterly disaster drills. LPA observed facility's infection control plan and emergency disaster plan which was last updated 6/25. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. Facility has an emergency back-up generator. At approximately 12:30 PM LPA conducted review of five (5) staff records. All required documentation present. At approximately 1:00 PM LPA conducted a review of five (5) resident records. All required documentation present. At approximately 1:30 PM LPA and Manager conducted a spot check of medication and medication records. Medication is centrally stored and locked. Administrator Recertification for Rashmika Mahawar was shown to have been submitted 10/24 and is still pending as of this visit. 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 : Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC610E - Emergency Disaster Plan No deficiencies cited. Exit interview conducted with Manager, whose signature on form confirms receipt.