Sea Breeze Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one-year inspection. LPA met with Teresita Tabayan, Owner and the purpose of the visit was discussed. Facility is licensed to serve 6 non- ambulatory residents age 60 and over . Currently the home has (1) resident.. None of the residents are diagnosed with dementia or receiving home health or hospice care services. The facility does not handle any of the residents’ money. This home is a single story home consisting of: (4) resident bedrooms, (1) Full bathroom, 1 half restroom, den, living room, kitchen with dining area, laundry room (located in the attached garage) and an outdoor shaded patio area. LPA toured the Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured between 108F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. During todays visit LPA did not observe any deficiencies. Exit interview conducted with Teresita Tabayan and a copy o this report was provided.the state’s words, verbatim · CDSS document, Feb 12, 2026

Type of visit: Required - 1 Year

On March 24, 2025, Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced Required Annual Inspection and met with Vergal Agatep, Administrator Facility is licensed to serve six(6) non-ambulatory/ambulatory clients ages 60 and above. Facility may retain three (3)hospice clients. Currently, facility census is 0 (As of 12/15/24) annual fees are current, liability insurance is active. The facility is a single-story structure located in a residential neighborhood. Facility consists of the following: four (4) client rooms, one (1) staff bedroom, one (1) common bathroom, two (2) private bathrooms and one (1) private half bathroom in room five (5), a living area, dining area, kitchen, outside covered patio area and an attached garage that houses a washer and dryer, an additional refrigerator, canned goods and also serves as storage space. All passageways, walkways, driveways, steps and patios are free from obstructions. LPA and Administrator toured facility inside and out. LPA observed no bodies of water on the premises. Bedrooms LPA inspected all (4) bedrooms All bedrooms were observed to have the required furniture including beds, dressers, night stands with lamps, chairs, and ample storage space for personal belongings. All bedrooms were observed to be clean, in good repair, and have ample lighting. Page 1 of 3 Bathrooms LPA inspected the facility bathrooms. In the resident’s bathroom the toilet, faucets, and shower were fully operational. All safety handrails were securely fastened. LPA observed the showers to be clean and free of mold or mildew. The shower had a nonskid material in bottom and shower chair. The water temperature measured 110 degrees Fahrenheit. All bathrooms were observed to be clean, in good repair and within Title 22 regulations. Linens & Hygiene LPA observed all beds to have the required linens including mattress cover, fitted sheets, blanket, comforter, and pillow. LPA observed an ample supply of linens, towels, and blankets in hall closet. Kitchen LPA inspected the kitchen and observed all appliances to be in good working repair, including stove/oven, microwave, refrigerator. LPA observed an ample supply of cutlery, pots, pans, and bowls to be in good repair. LPA observed knives and additional sharps to be secured in locked and inaccessible to residents. LPA observed a 2-day supply of perishable foods and a 7-day supply of nonperishable foods. Safety LPA observed and tested smoke/carbon monoxide combo detectors to be fully operable. LPA observed (3) fully charged fire extinguishers that was last serviced on 1/8/25 The last emergency drill was conducted on 5/3/24 LPA inspected the First Aid kit and found it contained an ample supply of required items: Scissors, tweezers, gauze, disinfectant wipes, band aids. LPA observed all exits to be clear and easily accessible. All toxins locked and inaccessible to residents in care. Medications: There are no medications to observe because there are currently no residents in facility at this time (as of 12/2024). LPA did observe where medications are stored which is locked and inaccessible to the residents. Page 2 of 3 Files LPA reviewed ( 2 ) former resident files and found that (2 ) out of (2) contained all the necessary documentation. LPA reviewed (2) staff files and found that (2 ) out of (2 ) contained the required documentation, certification, and training. Liability Insurance expires on 07/1/2025. Outside area: During visit LPA observed the outside grounds (front and back) to be free of clutter, debris, and passage ways were free of obstruction. There were no deficiencies cited during today’s visit. Exit interview conducted and copy of report provided to Vergal Agatep, Administrator. Page 3 of 3the state’s words, verbatim · CDSS document, Mar 24, 2025

Type of visit: Required - 1 Year

On 03/21/2024, Licensing Program Analysts (LPAs) Lizeth Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with administrator Vergal Agatep and explained the purpose of today’s visit. The facility is licensed to operate for six(6) non-ambulatory/ambulatory clients ages 60 and above. Facility may retain three (3)hospice clients. Current facility census is 3, annual fees are current, liability insurance is active. The facility is a single-story structure located in a residential neighborhood. Facility consists of the following: four (4) client rooms, one (1) staff bedroom, one (1) common bathroom, two (2) private bathrooms and one (1) private half bathroom in room five (5), a living area, dining area, kitchen, outside covered patio area and an attached garage that houses a washer and dryer, an additional refrigerator, canned goods and also serves as storage space. Client bedrooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathroom toilets and water faucets worked properly, shower was free of mold/mildew, non slip mats and grab bars observed, and there are sufficient toiletries accessible to clients. The water temperature properly measured between 105-120 F.. A supply of perishable and non-perishable food was observed, toxins and knifes were stored and inaccessible to clients. Auditory alarms observed and are operational, a land line was observed. There are no weapons nor bodies of water on the premises, exits and walkways are free of debris/hazards. LPA conducted a records review of 2 staff records, 2 client records, and 2 medication administration records, no discrepancies observed. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire was conducted on 12/10/23, 3 fire extinguisher fully charged, carbon monoxide and smoke detectors are interconnected and operational. Exit interview conducted with Vergal Agatep, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 21, 2024