Facility Evaluation Report

On August 12, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Administrator (AD) and Licensee Arvin Bumanglag and Linh Nguyen arrived shortly after and was present to assist with the facility inspection on today's date.

The facility is licensed for capacity six (6) residents of which two (2) can be non-ambulatory, four (4) ambulatory and one (1) bedridden residents. Facility has approved hospice waiver for six (6) residents. Currently, there are two (2) Hospice residents present during today’s visit.

This is a single story with a attached garage facility. The facility has three resident bedrooms, one full bathroom and one half bathroom.

At around 8:45AM, LPA Tirre conducted a tour of the physical plant accompanied by Caregiver, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, and bath towels were available during the visit. Bathrooms were operational with water temperature measured between 109.5 to 118.5 degrees F. A comfortable temperature of 74 degrees F. was maintained in the facility.

LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Facility has a fire extinguisher which was mounted and fully charged. CONTINUED ON 809C