Mydor's Open Guest Home, Inc. II

Type of visit: Required - 1 Year

Amended Version - updated 6/30/26 due to incorrect date noted for the fire extinguisher. Licensing Program Analyst (LPA) Rankin arrived at 9:18 am and made an unannounced 1-year required annual visit to the facility above. LPA met with Amelita Antonio and Juanito Pasion, both Administrators for the facility homes and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: The fire extinguisher was last charged and inspected on 2/25/2026. Fire sprinkler system was last inspected in June of 2025, it is due for it’s annual inspection this month. The facility has 5 bedrooms and 2 bathrooms currently occupying 6 residents. The facility has smoke and carbon monoxide detectors that were tested and working at time of visit. The lighting is sufficient for the use of the facility and for resident comfort. The toilet, hand washing and bathing facilities are operational and secure grab bars are present. The showers have non-skid mats and/or flooring. The pathways are clear of any obstructions. Disinfectants and cleaning solutions are inaccessible to residents in care. The facility has sufficient space inside and outside for activities and visiting. Operational Requirements: The facility has current liability insurance that expires on 12/30/26. The facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of 6. Fire clearance is granted for 6 bedridden residents. A hospice waiver is approved for 2 residents. Staffing Records and Training: The facility currently employs 7 staff, 5 are full-time caregivers, and 2 are administrators, if needed more staff can be pulled from other facilities nearby. Files reviewed had required documentation including but not limited to 1st Aid/CPR, Health screening with TB results, and Criminal Record statements. Administrator’s Certificate expires 1/16/27. Staff have annual training completed for various subjects/topics and hours for 2025 and 2026. Continued 809-C Resident Records & Incident Reports: Facility does submit incident reports to the department when required. LPA reviewed 4 resident files for, but not limited to signed Admission Agreements, Physician reports, Pre-appraisals, Appraisals Needs and Services Plan, all records were complete. Food Service: The facility has 2-day perishables and 7 day non-perishables to meet the food service requirement. All food is covered, stored, and marked appropriately. Cleaning solutions and equipment are stored separately from food supplies. Kitchen area is clean and equipment is clean and appears to be operational. Incidental Medical Services: Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed a sampling of residents’ medications, no labels were altered, no medications were expired, and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were reviewed. The facility conducts monthly fire drills, last one was on 5/16/2026 and quarterly disaster drills, the last one was 4/12/26. Emergency exits were posted. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility does not have delayed egress, locked doors or gates. Exit door alarms are working at time of visit. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Jun 9, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 11:47 am and made an unannounced 1-year required annual visit to the facility above. LPA met with Anna Teresa Tolentino, administrator, and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: The fire extinguisher was last charged and inspected on 1/2025. The facility has 5 bedrooms and 2 bathrooms currently occupying 6 residents. The facility has smoke and carbon monoxide detectors that were tested. The lighting is sufficient for the use of the facility and for resident comfort. The toilet, hand washing and bathing facilities are operational and secure grab bars are present. The showers have non-skid mats and or flooring. The pathways are clear of any obstructions. Disinfectants and cleaning solutions are inaccessible to residents in care. The facility has sufficient space inside and outside for activities and visiting. Operational Requirements: The facility has current liability insurance that expires on 1/30/26. The facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of 6. Fire clearance is granted for 6 bedridden residents. A hospice waiver is approved for 2 residents. Staffing Records and Training: The facility currently employs 5 full-time caregivers, 1 reliever and 1 administrator, if needed more staff can be pulled from other facilities nearby. Files reviewed had required documentation including but not limited to 1st Aid/CPR, Health screening with TB results, Criminal Record statements, and Fingerprint clearance. Administrator’s Certificate expires 1/16/27. Staff have annual training completed for various subjects/topics and hours for 2024 and 2025. Continued 809-C Resident Records & Incident Reports: Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for, but limited to signed Admission Agreements, Physician reports, Pre-appraisals, Appraisals Needs and Services Plan, all records were complete. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7 day non-perishables to meet the food service requirement. All food is covered, stored, and marked appropriately. Cleaning solutions and equipment are stored separately from food supplies. Incidental Medical Services: Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed a sampling of residents’ medications, no labels were altered, no medications were expired, and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts monthly fire drills, last one was in 7/4/2025 and quarterly disaster drills, the last one was 7/08/25. Emergency exits were posted. An emergency pamphlet was provided for future clarification and support. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility does not have delayed egress, locked doors or gates. Exit door alarms are working. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Jul 18, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Miller arrived at 8:20 am and made an unannounced 1-year required annual visit to the facility above. LPA met with Amelita Antonio, administrator and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Infection Control: The facility has a current Infection Control Plan. The facility has a sign in and out binder for visitors at entry with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectants sprays and cleaners. The facility has a 30-day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). Physical Plant & Environment Safety: The fire extinguishers were last charged and inspected on 1/22/24. All trash cans and wastebaskets have tight fitting covers. The facility has 5 bedrooms and 2 bathrooms currently occupying 6 residents. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors that were tested. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid mats. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant and cleaning solutions are inaccessible to residents in care and are locked in a cupboard in the garage. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use with plenty of shade. The facility has telephone and internet service for resident use. Continued 809-C Operational Requirements: The facility has a current plan of operation on file with the department. The facility has current liability insurance that expires on 1/30/25. The facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of 6. The fire clearance is granted for 6 bedridden residents. A hospice waiver is approved for 2 residents. The facility currently has 6 Non-Ambulatory residents. Staffing: The facility currently employs 4 caregivers and 1 administrator. Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. Administrator file was reviewed for Continuing Education requirements and Administrator Certificate expires 8/2/25. Personnel Records & Training: The facility keeps confidential files for each staff member. Staff have annual training completed for various subjects/topics and hours for 2023 and 2024. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, Physicians reports, Pre-appraisals, Appraisals Needs and Services Plans, (TCRC IPP) Emergency and ID forms, all forms were legible. Food Service: The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored, and marked appropriately. Cleaning solutions and equipment are stored separately from food supplies. Continued 809-C Incidental Medical Services: Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed residents’ medications, no labels were altered, no medications were expired, and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility last conducted a quarterly disaster drill 6/4/2024. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility does not have delayed egress, locked doors or gates. Exit door alarms are working. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Jul 19, 2024