Structure/Physical Plant The facility is a single-story structure in a residential neighborhood. It consists of five (5) resident bedrooms, 2 bathrooms, living room, dining room, sitting room, kitchen, laundry room, two (2) staff rooms, detached garage, a front yard, and a shaded patio area in the backyard with table and chairs. LPA did not observe any bodies of water on the premises. All outside walkways were observed to be clean, clear, and free of hazards, debris, and obstructions. All railings for ramps and stairs were secured and in good repair. All gates are accessible and open easily from the inside of the yards for an easy exit.

Bedrooms LPA inspected all bedrooms and found them to be clean and in good repair. All bedrooms contained the required furniture, including a bed, dresser, nightstand with lamp, chair, storage space for resident’s personal belongings, and ample lighting. All beds had the required linens including a mattress pad, fitted sheets, blanket, comforter, and pillow. LPA observed an additional supply of linens stored in the residents’ closets.

Bathrooms LPA inspected both bathrooms and found to be within Tittle 22 regulations. LPA observed the bathroom to be clean and operational. Both bathrooms have secured safety handrails, non-skid mats, and

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

Kitchen LPA inspected the kitchen and found it to be clean and sanitary. LPA observed an ample supply of dishware, cookware, and cutlery in good repair. All appliances were tested and observed operational and in good working repair. LPA observed a 3-day supply of perishable foods and a 7-day supply of non-perishable foods properly stored, packaged, and labeled. LPA observed all sharps and knives secured in a locked drawer in the kitchen and are inaccessible to residents. All cleaning supplies were observed secured in the locked cabinet under the kitchen sink and are inaccessible to residents. The water temperature measured 110.2-degrees Fahrenheit.

Common Rooms LPA inspected all common rooms and found them to be clean and in good repair. The facility was observed to be appropriately furnished during the time of visit. The living room and family room have two couches to accommodate all residents. LPA observed magazines and activities available for residents. The dining room has a large table and chairs and space to accommodate all residents. All walkways and hallways inside the facility were observed clean, clear, and free of obstructions and hazards. All rooms and hallways have ample lighting. The facility was maintained at a comfortable temperature.

Safety LPA observed two fully charged fire extinguishers mounted in the facility that were last serviced on 07/25/25. The last Fire Prevention Inspection was on 05/25/24. Smoke detectors and Carbon Monoxide detectors are in compliance and operational. The last Emergency Drill was conducted on 07/10/25. All exits are clearly indicated with an EXIT sign. LPA observed the Emergency Disaster Plan, posted in the kitchen, last updated 03/01/2025. LPA inspected the First Aid kit and found it contained the required items and a manual. LPA observed all required postings, posted throughout the facility. The facility has a working landline telephone. There are no firearms or ammunition stored on the premises.

Files LPA reviewed three (3) staff files and the administrators and found they contained the required documents, certification, clearance, and training. LPA observed the administrator’s Administrator Certificate, number 7006800740, is valid till 03/11/2027. LPA reviewed four (4) resident files and observed they had the required documents. LPA reviewed Liability Insurance through Kinsale that is valid till 07/12/2026. During facility file review, LPA observed licensing fees are current.

Medications LPA observed centrally stored medications secured in a locked cabinet in the kitchen and are inaccessible to residents. All medications were observed in their original packaging. LPA reviewed

Infection Control LPA observed the facility’s visitor sign-in procedures and temperature log. LPA observed sanitizing stations throughout the facility. The LPA observed all required infection control signs posted throughout the facility. LPA observed a 90-day supply of PPEs stored in the garage.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe or cite any deficiencies during today's visit.

LPA conducted an exit interview with Administrator, Bienvenido ‘Bien’ Cadungog, and a copy of this report was provided.