Facility Evaluation Report

On 01/16/26, Licensing Program Analyst, Wendy Gibbs, conducted an unannounced 1-year Required Annual Visit to the facility listed above using the full CAREs tool. LPA met with Nadine ‘Susana’ Sibayan, and the purpose of today’s visit was explained. LPA was granted entry into the facility.

The facility is licensed to serve six (6) non-ambulatory clients, age sixty (60) and over, four (4) of which may be bedridden, with an approved hospice waiver of four (4). There are currently six (6) residents residing in the facility.

Files The LPA reviewed six (6) resident files and found they contained the required documents. The LPA reviewed the Administrator and three (3) staff files and found they contained the required documents, training, and certification. LPA observed the administrator’s Administrator Certificate #7015514740 is valid till 04/02/2026, During record review, LPA observed licensing fees are current.

Medication LPA observed all Centrally Stored Medications secured in a locked cabinet in hall and are inaccessible to residents. All medications were observed in their original packaging. LPA reviewed the medication and Medication Administration Record (MAR) for six (6) residents. LPA observed six (6) out of six (6) resident’s MARs and medication are consistent with properly documented records.

Safety The LPA observed smoke detectors and carbon monoxide were operable. The LPA observed a fully charged fire extinguisher last serviced on 07/08/25. The last Fire Prevention Inspection was last conducted on 07/11/25, by the Torrance Fire Department. The last emergency drill was conducted on 09/25/25. LPA observed all exits clearly marked. LPA observed the Emergency Disaster Plan (LIC610E) posted and last updated on 02/21/2025. The facility has a working landline telephone. LPA reviewed and received a copy of liability insurance through Allied Health that is valid till 03/06/26. LPA inspected the First Aid Kit and found it contained the required items and a current manual. The LPA observed all mandated signs and documents posted throughout the facility.