Routine inspection·July 15, 2025

On 07/15/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct an annual visit. LPA was greeted by staff member (SM) Alona Bastida and explained the purpose of the visit. LPA asked that SM Bastida call the Facility Designated Administrator at this time to inform them that CCL was present. Shortly after, it was learned that the FDA was unable to come to the facility at this time. LPA met with Facility Designated Administrator (FDR), Necita Abellas. There was one other staff members present at the time of this visit, Ferdinand Estroba. This facility is licensed to serve 6 residents who are 60 and older and can be deemed non-ambulatory. This facility holds a hospice waiver for 6 and has a dementia program on file. Current census was 6. 1 out 6 residents were on an outing during the time of this visit. LPA reviewed 6 resident files. LPA reviewed 3 staff files. 3 out 3 staff files are complete and up to date. The administrator has an active administrator certificate #7034066740 and expires on 04/29/2027. A tour of the facility was conducted. Fire extinguisher located by the garage door appeared to have been purchased on 07/07/2025 and had an attached receipt to it. The kitchen area was toured. LPA Pascua observed a sufficient seven days of non-perishable as well as two days worth of perishable food supplies in the main kitchen. Additional perishable supplies were identified in an additional refrigerator located in the garage. Knives and additional cleaning supplies were locked and made inaccessible to the residents at this time. LPA Pascua observed a locked centralized stored medication cabinet located in the dining room. Along with Administrator, the LPA observed, reviewed, and compared resident medication with the medication dispensing logs. First Aid Kit was present and contained all of the required components. Common areas were toured. Living room, dining area and all other areas intended for resident use were in compliance and good repair. A tour of the garage was conducted. Additional storage for supplies were stored in cabinets. A washer and dryer were also identified in the garage. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. Grab bars were present and in good repair. A tour of the resident bedrooms was conducted. Resident furniture was observed to be sufficient to meet the resident needs at this time. A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time. Additional incontinence supplies were also identified. The exterior of the physical plant was in good repair with no hazards present. Perimeter fence was observed to be stable and gates were in good repair. The following forms and documents were requested to be updated and submitted into CCL. -LIC 308 -LIC 400 -LIC 500 -LIC 610 Based on the observations made during today's visit, there are no deficiencies were observed or cited during this annual visit. An exit interview was conducted and a copy of this report was given to Facility Designated Administrator.