Facility Evaluation Report

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for six non-ambulatory residents. Facility has an approved hospice waiver for six residents and the home currently has three residents. Administrator (AD) Restituto Calilung arrived shortly to conduct facility tour. AD provided updated liability insurance that expires on 4/3/2026.

LPA along with AD toured the facility at 1:05 PM. LPA toured the physical plant, checked food service, and facility documentation. The home consists of six resident bedrooms, living room, dining room, kitchen, three bathrooms and an attached garage along with an ADU for staff. The facility recently when through a remodel to add 2 bedrooms. Licensee is in process of applying for a new fire clearance to accommodate the 2 bedrooms. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. At 1:10PM, LPA observed bleach under the sink in the bathroom across bedroom 1 unsecured and accessible to residents. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 116.3 degrees F and 117.5 degrees F in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. LPA toured the kitchen and observed sharps locked in a cabinet during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts quarterly emergency drills with the last drill conducted on 10/5/2025. Continued on LIC809-C dated 1/28/26