Facility Evaluation Report
On 10/14/2025, Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA was greeted by Assistant Administrator, Kristine Tan and Caregiver, Ronaldo Marcos. LPA explained the purpose of today's visit.
LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed 2-day perishables and 7-day non-perishables, Facility has 5 resident bedrooms (4 private rooms and 1 shared room), 1 staff room, 2 full- bathrooms, kitchen, and common areas. The facility observed to clean, tidy and in good repair. Bedrooms were equipped with the required furniture for residents to use. Bathrooms are equipped with grab bars, and nonskid mats. Facility temperature is comfortable. Hot water temperature was measured at 106-116 degrees F.
Central stored medication, toxins and sharps objects were locked and inaccessible to residents. Staff training records were reviewed to be adequate.
Bed sheets, linens, and towels were observed to be sufficient and able to meet the needs of the residents at this time.
A review of (5) resident files was conducted and noted on the LIC 858.
A review of (3) staff files was conducted and noted on the LIC 859.
LPA requested for a copy of the LIC 400- Affidavit Regarding Client/Resident Cash Resources to be submitted to CCL by 10/16/2025.
No deficient is cite today. This report is reviewed and discussed with the asst. administrator and a copy is provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction