At 10:45 AM, the LPA initiated a walk-through of the facility.

LPA inspected four (4) random resident rooms on the first floor and four (4) random resident rooms on the second floor, and found them clean, well-lit, and equipped with the required furniture. Emergency pull cords were observed working next to the resident beds. LPA inspected the private bathrooms in these random rooms. The bathrooms contained grab bars, towels, a trash can, and non-slip flooring. The hot water temperature at the sink faucet was measured between the range of 116.3°F to 117.8°F. LPA inspected the common resident bathrooms with shower on both the floors and found it clean and sanitary. It contained soap, grab bars, a trash can, non-slip flooring, a curtain, and a shower chair.

LPA inspected the kitchen and found it clean. The refrigerator, freezer, and pantry were checked, and there was a sufficient supply of fresh perishable food for two (2) days and nonperishable staples for seven (7) days. No expired food items were found. Open food items were wrapped and dated.

LPA inspected the multipurpose/dining room and found it clean, with all the furniture in good repair. LPA observed residents participating in the activity and watching TV in the multipurpose room. All common areas were free from obstructions and hallways were well-lit.

Continued on LIC809-C

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

LPA inspected the basement and observed laundry room with industrial size and residential washer and dryers, car parking garage, and storage area with cleaning, paper products, and incontinence supplies.

LPA reviewed five (5) random client files and five (5) random staff personnel records. The LPA observed that 5 of 5 clients had the Admission Agreement, Physician's Report, Appraisal Needs and Services Plan. LPA observed that 5 of 5 staff members had First Aid/CPR training, LIC 508 Criminal Record Statements and LIC 503 Health Screening and confirmed that 5 of 5 staff members are associated with the facility.

LPA toured the patio yard area and found ramps and passageways in good condition, clear of obstructions, with no blocking or tripping hazards. These areas had patio tables, chairs, and umbrellas for residents’ use. Delayed egress was observed on all exit doors.

LPA observed a locked centrally stored medication cart located inside the medication room on the first floor. Medications were organized in separate bins for each resident. All medication bottles and bubble packs were properly labeled. Centrally Stored Medication Records (CSMR) were reviewed and found to be complete.

LPA inspected the first aid kit and found it fully stocked. Emergency Drill Logs were reviewed, and it was observed that Emergency Disaster Drills were conducted quarterly, with the most recent drill completed on 02/26/2025.

The following updated forms are requested to be submitted to CCLD by 05/16/2025:

1) LIC 500: Personnel Report 2) LIC 308: Designation of Facility Responsibility 3) Certificate of Liability Insurance 4)Administrator Certificate(s).

No deficiencies were cited during today's visit.

An exit interview was conducted with the Executive Director. A copy of this report was left with the Executive Director, Joshua Lambengco, whose signature on this form confirms receipt of the report.