Post-licensing visit·March 16, 2026

At approximately 12:30 PM, Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a post licensing inspection and met with Administrator Joy Dela Cueva. Facility is a Residential Care Facility for the Elderly (RCFE) with five (5) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for three (3), with one (1) Hospice residents currently in care, and is approved for all non-ambulatory residents. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 12:50 PM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Facility's fire extinguisher was observed charged and last serviced 3/25. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 112.4 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. LPA observed three (3) locked sheds in the backyard which LPA inspected and observed the contents to consist of old medical beds and assistive mobility devices. Facility pool was fenced off and LPA observed locks on two (2) of two (2) entrances. Continued LIC809C... Continued from LIC809... Facility has an internet access device and internet available to residents in care, and the phone was tested and operational during today's inspection. Facility conducts quarterly disaster drills, and the most recent drill was conducted 1/26. LPA reviewed emergency disaster plan which was last updated 3/26. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. Medication is centrally stored and locked. At approximately 1:20 PM LPA conducted a review of five (5) resident records. All required documentation present. At approximately 1:50 PM LPA conducted review of three (3) staff records. All required documentation present. Joy Dela Cueva Administrator Certificate 7004869740 expires 6/25/2026. Updated copies of the following documents shall be submitted to CCL by 4/17/2026 : Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC610E - Emergency Disaster Plan No deficiencies cited. Exit interview conducted with Administrator, whose signature on form confirms receipt.