Facility Evaluation Report

At approximately 1:00 PM Licensing Program Analyst Star Stevenson arrived unannounced to CONTINUE a required 1 year annual inspection and was greeted by caregiver Rei Justyne Tiamson who called her mom and administrator Maria Batungbakal.

At approximately 1:25 PM Administrator Maria Batungbakal arrived,

At 1:35 PM three (3) of 3 staff files and two (2) of 2 client files were reviewed. Clients are vendored through North Bay Regional Center. Administrator was advised to ensure all clients in care have signed Consent for Emergency Treatment (LIC627C) forms in client files.

Medicines were centrally stored and locked.

P&I monies were counted by administrator and do not go over their affidavit of client cash resources.

LPA requested the following documents to update facility file:

1)Updated LIC610D Emergency disaster plan.

2)Signed copies of LIC627C for 2 of 2 clients in care

*Updated Register of Clients/Residents (LIC 9020)(was obtained during today's inspection)

Documents to be submitted to Community Care Licensing (CCL) by due date of 06/20/2025

Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.