Mydor's Open Guest Home, Inc. III

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 2:05 pm and made an unannounced 1-year required annual visit to the facility above. LPA’s met with Administrator Anna Teresa Tolentino 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 facility has 5 bedrooms and 2 bathrooms currently occupying 6 residents. 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 and safety. Toilet, hand washing and bathing facilities are operational and secure grab bars are present. The pathways are clear of any obstructions. 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 fire extinguishers were last charged and inspected on 2/25/26. Facility has a Sprinkler that was inspected in June of 2025. Operational Requirements: The facility has a current plan of operation on file with the department. 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, all 6 can be bedridden and a hospice waiver is approved for 2 residents. Staffing Records & Training: The facility currently employs 5 caregivers, and 1 administrator. Files reviewed for, but not limited to current 1st Aid/CPR, Personnel Records/Application, and Health screening with TB results. 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, annual Physicians reports, Pre-appraisals, and Appraisals Needs and Services Plan, all forms were legible and complete. Food Service: The facility handles and prepares food safely. Kitchen was observed to be clean and all equipment operational. The facility has 2-day perishables and 7-day non-perishables to meet the food service requirements. All food is stored appropriately. 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 a monthly fire drill and quarterly disaster drill. 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 4, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 1:08 pm and made an unannounced 1-year required annual visit to the facility above. LPA’s met with Licensee Amelita Antonio and 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 facility has 5 bedrooms and 2 bathrooms currently occupying 6 residents. LPA was authorized to enter and inspect the facility. The facility has smoke and carbon monoxide detectors that were tested and were working at the time of visit. 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 secure grab bars are present. The showers have non-skid mats or non-skid flooring. 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 a telephone and internet service for residents’ use. The fire extinguishers were last charged and inspected on 1/13/25. Operational Requirements: The facility has a current plan of operation on file with the department. The facility has current liability insurance that expires on 1/30/26. The facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of 6, all 6 can be bedridden and a hospice waiver is approved for 2 residents. Staffing Records & Training: The facility currently employs 3 full-time caregivers, 2 relief staff and 1 administrator. Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Continued 809-C Criminal Record statements, and Fingerprint clearance/Associations/exemptions. Administrator file was reviewed for Continuing Education requirements and Administrator Certificate which expires 1/16/27. Staff have annual training completed for various subjects/topics and hours for 2024 and 2025. Resident Records & Incident Reports: Facility does submit incident reports to the department when required. LPA reviewed 4 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, Physicians reports, Pre-appraisals, Appraisals Needs and Services Plan, (TCRC IPP) Emergency and ID forms, all forms were legible, and records are kept confidential. 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 requirements. 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 a monthly fire drill and quarterly disaster drill. 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 15, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Miller arrived at 2:30 pm and made an unannounced 1-year required annual visit to the facility above. LPA’s 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 5 non-Ambulatory residents and 1 ambulatory resident. Staffing: The facility currently employs 3 vfull time caregivers, 3 relievers 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 Plan, (TCRC IPP) Emergency and ID forms, all forms were legible, and records are kept confidential. 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 6/10/2024. 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 16, 2024