Routine inspection·September 5, 2025

On 9/5/2025 at 10:55AM, Licensing Program Analysts (LPAs) Andrew Christy and Luisa Fontanilla arrived unannounced to conduct a Required - 1 Year inspection. LPAs met with caregiver, Amanaki Pomee, and explained the purpose of the visit. Administrator, Felomena Tabones, arrived 45 minutes later. Facility is currently at capacity with 6 residents. LPAs toured the facility including but not limited to bedrooms, bathrooms, dining area, kitchen, garage, and outdoor area. Smoke and carbon monoxide detectors were observed to be operational. Temperature inside facility is comfortable for residents and measured to 71 degrees Fahrenheit. Water temperature in the kitchen was measured to 113.9 degrees Fahrenheit. Fire extinguisher was observed to be full and last serviced on 09/10/2024. One week of nonperishable and 2-day of perishable food supplies were available. LPAs observed grab bars and non-skid mat in the bathrooms. There were adequate lights in each room. Resident rooms were observed to be cleaned and fully furnished. First Aid kit is complete. LPAs reviewed 5 residents and 4 staff files, and all staff files found to be complete. Emergency disaster plan was last reviewed 10/24/2024. Continued on LIC809C..... Continued from LIC809... The following deficiencies were cited during the visit: At 11:15AM, record review by LPA Andrew Christy found that some resident files were missing forms, such as the 601, 613C, 602, etc. This is considered a repeat violation. At 10:45AM, physical plant inspection by LPA Luisa Fontanilla found one of the pathways to the emergency exit was blocked by trash and various objects on the ground. At 10:15AM, various cleaning chemicals were found in an unlocked cabinet in the kitchen. This was fixed on site during LPA inspection. In addition, one Technical Violation was given for a resident having full rails on their bed. This issue was fixed on site and staff helped remove the rails during LPAs' visit. LPAs requested the updated versions of the following forms: LIC500, resident roster, Emergency Disaster Plan, Infection Control Plan, and liability insurance. Two Type A Violations (one of which a repeat violation) and one Type B Violation were cited during this visit. Further information on these deficiencies/citations can be found on forms LIC809D. Exit interview conducted, and a copy of this form, along with appeal rights, were provided to the administrator.