Indocare House 2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the facility to conduct an annual required inspection. LPA Valerio met with facility staff Orpha, and explained the purpose of the visit. LPA Valerio was later met administrator Teresita Lomendehe. LPA Valerio observed three staff on shift and six residents in care. LPA Valerio and facility staff toured the facility to ensure compliance with Title 22 regulations. LPA Valerio observed the facility living rooms to be fully furnished, clean, and free from odors. LPA Valerio observed six (6) resident bedrooms. Resident bedrooms were observed to be clean and free from odors. Emergency exits located in bedrooms were free from obstructions. Resident bathrooms were observed to be clean and sanitary. Hot water was measured within the regulatory range. The temperature inside the home was at a comfortable temperature. The facility was observed to have cameras in the home, which co-administrator Teresita stated they had completed proper paperwork with LPA Brown and had all residents sign necessary paperwork. Cameras were pointing towards exit ways and hallways. Residents were observed eating snacks, watching television, taking a nap, and or sitting in their bedroom. Staff were observed assisting residents with ADLs, preparing dinner, and administrative paperwork. The date of the last fire drill was 12/16/2025 LPA Valerio reviewed staff and resident files. Files were observed to be up to date with required annual documentation. LPA obtained the following annual documentation for the Regional Office Facility File: LIC 500, LIC 308, LIC 610, and copy of liability insurance. Per California Code of Regulations (CCR) - Title 22, no deficiencies were observed. An exit interview was held, and a copy of the report was providedthe state’s words, verbatim · CDSS document, Dec 30, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 11/7/24 at 8:30AM to conduct a Required - 1 year inspection visit. LPA met with Caregivers Orpha Manalansan and Luisito Manalansan and explained the purpose of the visit. Caregiver Orpha Manalansan contacted the Administrator regarding todays visit. Caregiver(s) are finger print cleared and associated to the facility. Licensing fees are current. Administrator certificate expires 7/1/2026. Licensing Information System (LIS) Facility Personnel Report Summary (roster) provided during this visit. LPA observed the facility has an Infection Control Plan on file. The facility is licensed for a capacity of 6 non- ambulatory residents of which 6 may receive hospice care services. LPA observed residents participating in individual activities during this visit. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed kitchen, dining area, bedrooms and bathrooms, storage areas, laundry and lighting throughout the facility. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. The temperature inside the facility was observed to be at 72*F which is within the required range of 68-85*F. The hot water temperature was measured at 110.7*F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA observed 2 staff and 2 resident file during this visit. Upon a file review the following items were discussed to be submitted with any changes annually: Licensing fees-Current Criminal Record Clearances LIS536-Current Administrative Organization LIC309-Current Designation of Administrative Responsibility LIC308-Submit Personnel Report LIC500-Submit Affidavit Regarding Client/Resident Cash Resources LIC400-NA Surety Bond LIC402-NA Facility Floor Plan/Plot Plan LIC999-Current Fire Clearance (consistent with terms and limitations of license)-NA Qualifications of Administrator/Facility Manager-Submit Articles of Incorporation/Organization, Constitution and bylaws-NA Partnership Agreement-NA Control of Property-Submit Emergency Disaster Plan LIC610-Submit Plan of Operation (Restricted Health Care Plan)-NA Admission Policies and Procedures-NA Health Screening Report-Facility Personnel LIC503-NA Bacteriological Analysis of Private Water Supply-NA In-service Training Program-NA Medication Procedures-NA Transportation Procedures-NA Job Description/Personnel Policies-NA Exemptions/Waivers and Exceptions-Current First aid/CPR certificates-Current Liability Insurance-(if applicable)Submit Infection Control Plan-(if applicable)Submit Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. Exit interview held. A copy of todays’ report provided.the state’s words, verbatim · CDSS document, Nov 7, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 12/7/23 at 9:00AM to conduct a Required - 1 year inspection visit. LPA met with Caregivers Orpha Manalansan and Luisita Manalansan and explained the purpose of the visit. Caregiver Orpha Manalansan contacted the Administrator regarding todays visit. Caregiver(s) are finger print cleared and associated to the facility. Licensing fees are current. Administrator certificate expires 7/1/2024. Licensing Information System (LIS) Facility Personnel Report Summary (roster) provided during this visit. LPA observed the facility has an Infection Control Plan on file. The facility is licensed for a capacity of 6 non- ambulatory residents of which 6 may receive hospice care services. LPA observed residents participating in individual activities during this visit. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed kitchen, dining area, bedrooms and bathrooms, storage areas, laundry and lighting throughout the facility. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. The last documented quarterly emergency drill was conducted on 9/1/23. The temperature inside the facility was observed to be at 73*F which is within the required range of 68-85*F. The hot water temperature was measured at 108.9*F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA observed 2 staff and 1 resident file during this visit. Upon a file review the following items were discussed to be submitted with any changes annually: Designation of Facility Responsibility (LIC308), Personnel Report (LIC500), Administrator Certificate-Updated, Liability Insurance-updated, Any updates/Addendum to Infection Control Plan Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview held, copy of report giventhe state’s words, verbatim · CDSS document, Dec 7, 2023