Primetime Board & Care Home

Type of visit: Required - 1 Year

At approximately 9:45 AM, Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a required 1-year annual inspection and met with Licensee Thelma Sy and Licensee/Administrator Danilo Sy. Facility is a Residential Care Facility for the Elderly (RCFE) with three (3) residents in care. Facility has a Dementia Care Plan and is approved for all non-ambulatory residents. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 10:15 AM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Facility's fire extinguisher was observed charged and last serviced 5/26. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 113 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. Administrator stated backyard has been recently paved and a gazebo will be set up to provide a shaded seating area. Facility has an internet access device and internet available to residents in care, and the phone was tested and operational during today's inspection. Continued LIC809C... Continued from LIC809... Facility conducts quarterly disaster drills, and the most recent drill was conducted 3/26. LPA reviewed emergency disaster plan which was last updated 5/26. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 11:20 AM LPA conducted a review of three (3) resident records. All required documentation present. At approximately 11:45 AM LPA conducted review of three (3) staff records. All required documentation present. At approximately 12:10 PM LPA and Administrator conducted check of P&I. All records present and cash is reconciled. Administrator has increased their bond amount, updated bond and LIC400 were given to LPA. At approximately 12:20 PM LPA and Administrator conducted a spot check of medication and medication records. Medication is centrally stored and locked. Danilo Sy Administrator Certificate 7034479740 expires 02/20/2027. Updated copies of the following documents were gathered during this visit: Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC402 - Surety Bond LIC610E - Emergency Disaster Plan No deficiencies cited. Exit interview conducted with Administrator, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Jun 25, 2026

The state marks this report as 4 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 approximately 12:40 PM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by caregiver. Licensees Danilo Sy and Thelma Sy were called and arrived at approximately 1:15 PM. Facility is a Residential Care Facility for the Elderly (RCFE) with two (2) residents in care. Facility has a Dementia Care Plan and is approved for all non-ambulatory residents. Residents were at day program during this visit and returned as LPA was leaving. At approximately 1:20 PM, LPA initiated a tour of the facility with Licensees and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguisher was observed charged and last inspected 6/24. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 111.7 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. There is a shaded seating area in the backyard with outdoor space for activities. Facility has an internet access devise and internet available to clients in care. Facility conducts quarterly disaster drills, and the most recent drill was conducted 3/25. Continued 809C... Continued from 809... LPA observed facility's infection control plan and emergency disaster plan. LPA informed Licensees of the need to sign and review disaster plan every year regardless if there has been no changes. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 2:00 PM LPA conducted review of two (2) staff records. All required documentation present. At approximately 2:20 PM LPA conducted a review of two (2) resident records. All required documentation present. At approximately 2:30 PM LPA and Licensees conducted check of P&I. All records present and cash is reconciled. At approximately 2:40 PM LPA and Licensees conducted a spot check of medication and medication records. Medication is centrally stored and locked. Thelma Sy Administrator Certificate 7006452740 expires 10/25/2026. All fees are current as of this time. Updated copies of the following documents shall be submitted to CCL within 30 days of this visit: LIC610E - Emergency Disaster Plan Updated copies of the following documents were gathered during this visit: Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC402 - Surety Bond No deficiencies cited. Exit interview conducted with Licensee, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Jun 6, 2025

The state marks this report as 4 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 approximately 8:45 AM, Licensing Program Analyst (LPA) Stefanie Mutialu conducted an unannounced Annual Required inspection to this facility and was greeted by Administrator/Licensee Thelma Daezsy. At approximately 9:00 AM, LPA and Administrator/Licensee toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. Toxins are secure and not accessible to clients. Medication willl be centrally stored and secure in a cabinet. There is a sufficient supply of linens on hand for client use. No clients admitted at this time awaiting North Bay Regional for client placement. No current personnel files to be reviewed. Two out of two water faucets were inspected and found to be within regulation. Water temperature measured within regulation between 109 and110 degrees F at faucets accessible to clients. Seven out of seven smoke detectors and one out of one carbon monoxide detector were inspected and found to to be in working order. One out of one fire extinguisher was fully charged. Administrator's Certificate for Danilo Sy certificate #7034479740 is current with an expiration date as of 02/21/2025. No deficiencies were observed in the areas inspected. No citations issued during today’s visit. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC308- Designation of Responsibility Updated Liability Insurance Surety Bondthe state’s words, verbatim · CDSS document, Jun 26, 2024