Routine inspection·June 11, 2025

At approximately 9:20 AM, Licensing Program Analyst (LPA) Robert arrived unannounced to conduct a 1-Year Required Visit and was greeted by Staff Member, Laurel Roque. Licensee/Administrator, Luingning “Bot” Alicdan, arrived during the visit at approximately 9:50 AM. Facility serves older adults and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance and total capacity for 13 residents of which 11 residents can be non-ambulatory, and 2 residents can be bedridden. Facility has an approved hospice waiver for 3 individuals. Facility has approval to have a locked perimeter. Upon arrival, LPA was informed that there were twelve (12) Residents in care and 3 staff members on-site. 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 9:50 AM, LPA toured the facility with Administrator Alicdan. All exits were clear and unobstructed. Facility fire extinguishers were last serviced and tagged in May, 2024. Fire extinguisher servicing and inspection is scheduled for 6/27/2025. The automatic sprinkler system was serviced in 5/2025. The facility was sufficiently lighted. LPA inspected eight (8) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. LPA observed that six (6) various dressings and sauces that were required to be refrigerated after opening, were left unrefrigerated in a kitchen cabinet. This deficiency will be cited. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills quarterly. The last disaster drill was conducted on 5/19/2025. Continued on 809-C... ...Continued from 809 The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. At approximately 11:30 AM, LPA reviewed five (5) resident files. Three (3) resident files were observed to not have current Needs & Service Plans. This deficiency will be cited on the corresponding Non-Compliance inspection. LPA reviewed four (4) staff files. Two (2) staff members were observed not to have current 1st Aid and CPR training. Three (3) staff members were observed not to have initial training documents. These deficiencies will be cited on the corresponding Non-Compliance inspection. LPA observed a medication cabinet in common area, next to the storage room, to be unlocked. This deficiency will be cited on the corresponding Non-Compliance inspection. LPA spot checked Medication for three (3) residents. LPA observed all medications to have proper documentation. The facility does not handle resident’s monies for personal and incidental items. Luningning Alicdan’s Administrator Certification 7002894740 is pending renewal. Administrator bureau received application on 10/10/2023. LPA requested the following documents be submitted to Community Care Licensing by 7/11/2025: LIC 500 Personnel Report LIC 308 Designation of Responsibility LIC 610E Emergency Disaster Plan Proof of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809D, LIC 421FC, Plan of Corrections and Appeal Rights discussed and provided to Licensee/Administrator Alicdan. Signature on form confirms receipt of documents.