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Type of visit: Required - 1 Year

At approximately 09:45AM, Licensing Program Analyst (LPA) Ali Deniz conducted an unannounced Annual Required one (1) year inspection for this facility. LPA was greeted by Licensee/Administrator, Josephine Sana. The facility is licensed for capacity of four (4) non-ambulatory residents. The facility currently provides care for 4 residents, none of which are receiving hospice services. One of four resident was attending day program during visit. Facility is a single story building with four (4) Resident bedrooms, two and hald (2.5) bathrooms, and common spaces. At approximately 10:25AM, LPA toured the building with administrator, Josephine Sana and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Cleaning supplies and other toxins are safely stored in a locked cabinet in the laundry room and garage all of which were secured upon inspection. Sharps and other kitchen supplies that could pose danger if available to residents were found secured in a kitchen drawer. Water was measured at faucets accessible to residents between 110.2 and 113.6 degrees F which is within regulation between 105 and 120 degrees F at faucets accessible to residents. Fire Extinguishers found throughout the facility to be recently charged on 06/23/2025 at the time of visit. Smoke and carbon monoxide detectors are interconnected throughout the facility, tested and found to be functioning. There was enough lighting in all common areas, resident rooms, and hallways. Facility has a generator to supply power during an outage. LPA observed emergency lighting for an emergency. need Medications located in designated medication room on the hallway area and were found to be secured. LPA conducted a spot check of medications and found all medication records to be in order. Continued on LIC809-C page... Continued from LIC809 page... At approximately 11:50AM, LPA reviewed three (3) resident records and found all residents have current needs & service plans and signed admission agreements. LPA also reviewed three (3) staff records and found all records were containing required documents per regulation. LPA was presented with proof of current CPR & First-Aid certification for all the members. Administrator Certificate for Josephine Sana #7003793740 expires on 02/21/2028. LPA reviewed the facility emergency disaster plan. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducted and documented a disaster drill on 04/09/2026. LPA reviewed P&I money on and learned that four (4) out of four (4) clients P&I money are accurate and available for review at this time. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC 308 Designation Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Resident’s Copy of Updated Certificate of Liability Insurance No deficiencies were observed in the areas inspected, No citations were issued during today’s visit. Exit interview conducted. Copy of report provided to Licensee/Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Apr 23, 2026

Type of visit: Required - 1 Year

At approximately 09:50AM, Licensing Program Analyst (LPA) Ali Deniz conducted an unannounced Annual Required – 1 yr. inspection for this facility. LPA was greeted by staff, Conatel Garcia. Administrator, Josephine Sana was contacted and arrived later in the visit. The facility is licensed for 4 non-ambulatory residents. The facility currently provides care for 4 residents, none of which are receiving hospice services. Facility is a 1 story building with 4 Resident bedrooms, 2.5 bathrooms, and common spaces. At approximately 10:20AM, LPA toured the building with administrator, Josiphine Sana and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Cleaning supplies and other toxins are safely stored in a locked cabinet in the laundry room and garage all of which were secured upon inspection. Sharps and other kitchen supplies that could pose danger if available to residents were found secured in a kitchen drawer. Water was measured at faucets accessible to residents between 108.7 and 110.4 degrees F which is within regulation between 105 and 120 degrees F at faucets accessible to residents. Fire Extinguishers found throughout the facility to be recently charged on 5/21/2024 at the time of visit. Smoke and carbon monoxide detectors are interconnected throughout the facility, tested and found to be functioning. There was enough lighting in all common areas, resident rooms, and hallways. Facility has a generator to supply power during an outage. Medications located in designated medication room in the hallway area and were found to be secured. LPA conducted a spot check of medications and found all administering and records to be in order. Continued on LIC809C... Continued from LIC809... At approximately 12:10PM, LPA reviewed 4 resident records and found 4 out of 4 residents were containing current Needs & Service Plans and signed admission agreements. Upon review, LPA found that Physician's Reports for 3 out of 4 residents needs to be updated. 3 of 4 Resident’s Physician’s reports weren’t filled all sections in the report by resident’s Physicians. LPA recommended licensee to update residents Physicians Report and make sure all the sections are filled in the report. At approximately 12:35PM, LPA reviewed 3 staff records. 3 out of 3 records were containing required documents per regulation. LPA was presented with proof of current CPR & First-Aid certification for all staff. Administrator Certificate for Josephine Sana #7003793740 expires on 02/21/2026. At approximately 1:15PM, LPA reviewed the facility emergency disaster plan. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducted and documented a disaster drill on 04/07/2025. LPA reviewed P&I money on and learned that 4 out of 4 clients P&I money are accurate and available for review at this time. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Resident’s Copy of Updated Certificate of Liability Insurance Copy of LIC 402 Surety Bond No deficiencies were observed in the areas inspected, No citations were issued during today’s visit. Exit interview conducted. Copy of report provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Apr 24, 2025

Type of visit: Required - 1 Year

On 4/12/2024, Licensing Program Analysts (LPAs) Mutialu and Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by staff, Conatel Garcia and Jesusan Icang. Administrator, Josephine Sana was contacted and arrived later in the visit. The facility is licensed for 4 non-ambulatory. The facility currently provides care for 4 residents, none of which are receiving hospice services or with a diagnosis of dementia.. LPAs continued with a tour of the facility with Administrator, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers found throughout the facility to be recently charged on 7/21/2023 at the time of visit. Smoke and carbon monoxide detectors are interconnected throughout the facility, were tested and found to be functioning. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations, with food stored in the kitchen refrigerator found to have appropriate labeling. Staff provide residents with meals according to dietary restrictions with an ample amount of fresh and healthy foods observed. Cleaning supplies and other toxins are safely stored in a locked cabinet in the laundry room and garage all of which were secured upon inspection. Sharps and other kitchen supplies that could pose danger if available to residents were found secured in a kitchen drawer. There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings and bedding items. Water was measured at faucets accessible to residents and measured between 111.7 and 116.6 degrees F which is within regulation. Continued onto LIC809-C Medications located in designated medication room in the hallway area and were found to be secured. LPAs conducted a spot check of medications and found all administering and records to be in order. Residents that were awake during the inspection were observed interacting with staff in the common area, in their bedroom watching television or visiting with family. The facility also offers regular family visits and gatherings as well as encouraging residents to exercise and increase their mobility. There is one emergency exit located in the backyard which was found to be unobstructed. There is an outdoor patio with outdoor umbrella providing shade and large outdoor space for residents to utilize with exits equipped with ramps for accessibility. The facility conducts emergency disaster drills and provided documentation to LPAs for review. LPAs observed driveway cement cracked and uneven in two locations leading from emergency exit path. Per Administrator and Brilliant Corners maintenance service person, request for repair has been submitted. Licensee agrees to provide update of repair completion. Technical Advisory issued. LPAs conducted a sample file review for staff and found all staff to have appropriate annual training and 1st Aid & CPR certification on file. LPAs also conducted a file review for all residents. Upon review, LPAs found that all resident Needs & Service Plans and Physician's Reports to be current. LPAs recommended licensee to update resident (R!) Physicians Report. All required positing and signeage at the front and hallway of the facility were found to be in order with information easily accessible for staff and residents. Administrators Josephine Sena's Administrator Certification 6013529740 is currently pending for renewal. Documentation of training and status on pending list provided to LPAs. Administrator Jennica Narciso's Administrator Certification 6018481740 is valid through 9/24/2024. LPA requested the following documents be sent to CCL by COB 5/12/2024: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Liability Insurance Control of Property/Rental Agreement No deficiencies citedthe state’s words, verbatim · CDSS document, Apr 12, 2024