Facility Evaluation Report

On April 17, 2025, Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA was greeted by caregiver, Jannette Sumampong. LPA explained the purpose of the visit. The house manager, Rivina Timuat and the administrator, Gianne Vizconde arrived shortly thereafter and assisted with the inspection.

LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. LPA toured inside and outside including all of resident rooms, common areas, and kitchen area. The indoor and outdoor passageways were free of obstruction. Comfortable temperature is maintained and lighting is sufficient for comfort.

LPA observed 5 resident rooms (5 private rooms) and 1 staff room. Rooms were spacious and included all required furnishings besides resident #1 (R1)'s room where therew as no lamp and no appropriate lighting. Bathrooms/Shower rooms were observed to be clean; equipped with paper towels, soap, and grab bars but slip-resistant mats were not observed., Hot water temperature in the kitchen, and bathroom was measured at 106- 108 degrees F. 2 days for perishables and & 7 days non-perishable were observed to be present.

Sharps, chemicals, and medications were observed to be locked and inaccessible to residents in care.

Facility is equipped with smoke detectors and carbon monoxide detectors. Fire drill records were reviewed. Fire extinguishers were last inspected on 4/8/2025.

A review of (5 ) facility resident records was conducted.

A review of (3) facility staff records was conducted.

Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties.

This report is reviewed and discussed caregiver. A copy is provided and the appeal rights.