Agape Senior Living

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Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation using the CARE Inspection Tool. LPA was greeted and granted entry by Caregiver Tania Tambunan and explained the reason for the visit. Administrators (Admin) Cosmin Surgent and Natalia Surgent arrived approximately 8-9am. LPA observed two caregivers on duty providing care to six residents of which one is under hospice care. The third caregiver was off duty resting in the staff bedroom. The Administrator's Certificate for Natalia Surgent expires on February 10, 2026 and March 12, 2026 for Administrator Cosmin Surgent The following was observed during the inspection: This is a single story structure located in a residential neighborhood. Facility operates within the conditions and limitations specified on the license. There are six private resident bedrooms, two resident bathrooms, and one private staff bedroom. All common areas were inspected including the two secured sheds in the backyard. The residents' bedrooms were appropriately furnished. Beds and bedding supplies were in good condition, adequate lighting was provided, sufficient storage space for each residents' personal belongings were observed. There were no bed rail orders present for two out of six residents, Resident #1 (R1) and Resident #4 (R4). Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 105.4 and 109.4 degrees Fahrenheit in the resident bathrooms. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food. LPA toured the exterior portion of the facility. LPA observed the outdoor passageway is free of obstruction. The exit gate was operational and there were sufficient seating and shading. The fire extinguishers were mounted, charged, and serviced on February 7, 2025. The auditory devices and dual functioning smoke/carbon monoxide detectors were tested and operational. LPA observed four baby cameras in the bedrooms of R1, Resident #3 (R3), R5, and Resident #6 (R6). Per review of the resident records, facility obtained the written consent from the families. The baby monitor and cameras were removed during the visit. Admins were advised that the Department will follow up on the use of cameras. The surveillance cameras in the common areas are not active and will be removed per Admin Cosmin. LPA observed the emergency food/water in the pantry and garage. Emergency evacuation drills are being conducted quarterly with the last date on July 8, 2025. LPA observed the required 'See Something, Say Something' (PUB475) poster posted in the correct size in the entry way. LPA conducted interviews and audited six residents' files and two personnel files in which no discrepancies were found. Medications were audited for two out of six residents. No discrepancies noted. LPA consulted the following: to obtain half bed rail orders for R1 and R4. Based on the observations made during today's visit, a deficiency is being cited. An exit interview was conducted with Administrators Natalia Surgent and Cosmin Surgent, and a copy of this report including the appeal rights were provided at exit.the state’s words, verbatim · CDSS document, Sep 12, 2025

Type of visit: Required - 1 Year

On August 22, 2024, at 2:00pm, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrator (AD) Natalia Surgent and explained the purpose of the visit. The facility is licensed to operate for six (6) non-ambulatory of which one (1) may be bedridden and have a hospice waiver for three (3) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: six (6) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, family area, dining room, kitchen, attached 2-car carport, two sheds out in the backyard, and an outside covered patio area. LPA Kim toured indoor and outdoor of the physical plant with AD Surgent. There are no obstructions or bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. The fireplace is covered with a screen. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, Resident Room 5, Resident Room 6, and Staff Room 1. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between 106.8 degrees F and 107.7 degrees F. A comfortable temperature of 78 degrees F was maintained in the facility. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, water, supplies are stored in the pantry and extra emergency water in the dining room. The facility has two (2) fire extinguisher that is charged, mounted in the kitchen and in the residential hallway, and both were serviced in February 23, 2024 and smoke/carbon monoxide detectors were operable. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). The facility conducts Fire/Safety Drill quarterly and was last conducted June 7, 2024. A working telephone (657-258-0007) remains available. First Aid Kit contained all the necessary elements. LPA conducted an audit of resident files (R1-R5), staff files (S1-S3) and medication and medication administration review that were all in order and complete. LPA Kim conducted 3 resident interviews and 1 staff interviews. An exit interview was conducted and a copy of this report was provided to Administrator Natalia Surgent.the state’s words, verbatim · CDSS document, Aug 22, 2024