My Family Residential Care Home

Type of visit: Required - 1 Year

At 12:34 am on 04/09/2026, Licensing Program Analyst (LPA) Rankin arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Administrator Michelle Tantingco announced who they are and the reason for 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 facility is a 7 bedroom and 6-bathroom. The facility occupies 6 residents and employs 4 staff of which one is the Administrator. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. LPA noted that all resident bedrooms had required furnishings and bedding by regulations requirements. The facility has smoke and carbon monoxide detectors. Carbon Monoxide and smoke alarms were tested and working properly at time of visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The showers have non-skid mats/flooring. Toilet, hand washing and bathing facilities are operational and secure grab bars are present. The pathways are clear of any obstructions. Disinfectants, cleaning solutions and poisons are inaccessible to residents. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard for client use with furniture and plenty of shade. The backyard has 2 locked sheds to store extra items, including yard tools. Operational Requirements: The facility has a current plan of operation on file. The Facility is operating in compliance with the granted fire clearance based on the facility sketch. The facility has current liability insurance and expires on 03/04/2027. The facility is approved for a capacity of 6 non-Ambulatory and approved for hospice waiver of 6. Continued on 809-C Staffing, Personnel Records & Training: LPA reviewed 4 staff files. Administrator certificate expires 08/30/2026. Staff files reviewed had all required documentation including current 1st Aid and CPR certificates. All annual training has been completed for the last 12 months. Resident Records & Incident Reports: All 6 files were reviewed for required documentation including updated Medical Assessments, and Appraisal Needs and Services plans (ANS). All records were complete. Incidental Medical & Dental: The facility has a medication cabinet that is kept locked. Facility provides or assists in providing transportation to medical and dental appointments when needed. A sampling of medications records were reviewed. Facility has Centrally Stored Medication Destruction Record (CSMDR) on all residents, and the documentation is up to date. PRN Authorization documents are on file. No medications labels were altered, no expired medications, and medications were stored in original containers. 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 and stored appropriately. Fresh fruit and vegetables were noted by LPA. Food, snacks and drinks are available when the residents want them. Cleaning solutions and equipment are stored separately from food supplies. Kitchen areas are kept clean. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts disaster drills quarterly, last one done on 1/20/26. The fire extinguishers were charged and last inspected on 1/22/26. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or inaccessible to residents in care. The facility does not have delayed egress. The facility does have 1 hospice residents in care. Hospice services records are kept on file. The facility gates are self-latching and self-closing. The backyard is completely fenced. Exit interview conducted, copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Apr 9, 2026

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At 10:00 am on 04/10/2025, Licensing Program Analyst (LPA) Rankin arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Administrator Michelle Tantingco announced who they are and the reason for the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: The facility is a 7 bedroom and 6-bathroom. The facility is occupying 5 residents and employs 4 staff of which one is the Administrator. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. LPA's noted that all resident bedrooms had required furnishings and bedding by regulations. The facility has smoke and carbon monoxide detectors. Carbon Monoxide and smoke alarms were tested and working properly at time of visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The showers have non-skid mats/flooring. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard for client use with furniture and plenty of shade. The facility has telephone and internet service for resident use. The backyard has 2 locked sheds to store extra items, including yard tools. Operational Requirements: The facility has a current plan of operation on file. The Facility is operating in compliance with the granted fire clearance based on the facility sketch. The facility has current liability insurance and expires on 03/04/2026. The facility is approved for a capacity of 6 non-Ambulatory and approved for hospice waiver of 6. Continued on 809-C Staffing, Personnel Records & Training: Staff records are kept confidential. LPA reviewed 4 staff files and administrator training's. Completion of administrator training is done and application is being submitted. Current certificate is expired, and a citation was given. Staff files reviewed had current 1st Aid, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/ exemptions. All annual training is complete with the exception of one staff who is scheduled to completed final few hours of training by the end of April. Resident Records & Incident Reports: The facility keeps separate files on each resident confidential. A sampling of files were reviewed for signed Admission Agreements, Medical Assessments, LIC. 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS), TB results, Personal Rights, and Safeguard for personal property and valuables all files were complete. Incidental Medical & Dental: The facility has a medication cabinet in the living room that is kept locked. Facility provides or assist in providing transportation to medical and dental appointments when needed. The medications records were reviewed, and all residents had a Centrally Stored Medication Destruction Record (CSMDR). Administrator maintains a record of PRNs provided; and has PRN Authorization documents on file. LPA reviewed all residents’ medications, no medications labels were altered, no expired medications, and medications were stored in original containers. 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, and stored appropriately. Fresh fruit and vegetables were noted by LPA. Food, snacks and drinks are available when the residents want them. Cleaning solutions and equipment are stored separately from food supplies. Kitchen areas are kept clean and free from litter, rodents, and insects. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts disaster drills quarterly. The fire extinguishers were charged and last inspected on 1/30/25. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or inaccessible to residents in care. The facility does not have delayed egress. The facility does have 3 hospice residents in care. Hospice services records are kept on file. The facility gates are self-latching and self-closing. The backyard is completely fenced. Exit interview conducted, citation given and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Apr 10, 2025

Type of visit: Case Management - Annual Continuation

At 8:15am on 04/19/2024, Licensing Program Analyst (LPA) arrived unannounced to conduct the continuation of the annual facility inspection. LPA met with Administrator Michelle Tantingco, announced who he is and the reason for the visit. Administrator and LPA conducted a second physical inspection of the facility as part of the continuation annual inspection. LPA noted that this is a 7 bedroom and 6 bathroom (Six single resident occupancy, and one staff room) facility with two living room areas, one dining room, a large back yard with fixed pergola that provides shade for residents, visitors, and staff. Medications are kept in a cabinet in the living room with lock on the door. Staff and Resident files are kept in a locked file cabinet in the living room number one. LPA observed at least 2 days of perishable and at lease 7 days of non perishable foods on hand for six residents and staff. LPA noted that the facilities first aide kit is complete by regulations and is located in the dining room area. LPA conducted a sample medication audit and found all Centrally Stored Medication Records (CSMR) to complete and accurate. LPA conducted a file review of staff and residents files and found all files to be compete and current (LIC602's with in 12 months for 5 of 6 residents). LPA noted that the fire extinguisher is rated in the green range. LPA tested smoke detectors and carbon monoxide detector and found them to all be operational. LPA noted that the facility was clean and in good repair. LPA noted that between the initial visit for annual inspection and the return continuation visit. Administrator replaced the hood over the stove to mitigate the oil build up that was on the old hood. LPA noted that no citations were issued as a result of the physical inspection. Administrator and LPA conducted a full review of the annual care tools modules. LPA noted that there were no technical. violations, or citations issued as a result of the annual care tools module review. LPA noted that no violations or citations were issued as result of this annual facility inspection. Exit interview, report read, report singed, and report provided.the state’s words, verbatim · CDSS document, Apr 19, 2024

Type of visit: Required - 1 Year

At 2:05pm on 04/16/2024, Licensing Program Analyst's (LPA's) Rankin and Jeffries arrived unannounced to the facility to conduct the facility annual inspection. LPA's met with facility administrator Michelle Tantingco, announced who they are and the reason for the visit. LPA's conducted a physical inspection of facility. LPA's, due to time constraints need to conclude the remainder of the inspection today. LPA's will return to continue the annual inspection at a later. Exit interview, report read and report provided.the state’s words, verbatim · CDSS document, Apr 16, 2024