Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA was met by James Alfonso Loppies, Caregiver and explained the purpose of the visit. The administrator, Jacklyn Peng Lee Concepcion was called and arrived at 11:45am to assist LPA with the inspection. The facility is approved to serve residents age range 60 and over, (6) non ambulatory, of which (1) may be bedridden. Hospice waiver approved for (3) residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: The facility is continuing to follow their Infection Control Plan . Administrator reviewed and updated the Infection Control plan annually. Staff are trained in the proper use of all required PPEs.

Operational Requirements: Plan of operation was reviewed. The facility accepts and retains residents with dementia. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 07/24/2026.

Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood which consists of (4) resident bedrooms, (2) staff bedrooms, (1) with en-suite bathroom, (1) communal bathroom, living room with fireplace, dining area with fireplace, kitchen, laundry area, attached garage, and backyard with shaded area with tables and chairs. There are currently (6) residents, 60 years and older residing in the facility, (2) are under hospice care and (1) bedridden. The interior and exterior physical plant was inspected. LPA observed both fireplaces to be uncovered, unsecured and accessible to residents. Resident bedrooms were toured. Each bedroom has a bed, linen, light, chair and sufficient closet space. There are (3) refrigerators/freezers, (2) in the kitchen/dining area and (1) near the laundry area. There are no working auditory devices in the exit points. The backyard was inspected and was observed to be disorganized with miscellaneous junk and toxic materials around the area. There are (2) fire extinguishers in the facility and one purchased in December 2025 was not mounted on the wall. Smoke detectors and carbon monoxide detectors were tested and operable. The facility is not following the existing sketch as one of the designated room for the resident has been changed to a staff room. There are cameras with audio at the facility. The hot water temperature was measured between the requir ed range of 105-120 degrees F. *****REPORT CONTINUED ON LIC809-C*****