Routine inspection·September 17, 2025

On 09/17/2025 at 12:20PM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Natividad Masiddo, Caregiver and explained the purpose of the visit. Administrator, Jamie Bernardino-Ruiz arrived at 12:42PM. The facility’s fire clearance was approved for five (5) non-ambulatory and one (1) bedridden resident. LPA toured facility with Jamie including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of ten (10) bedrooms, four (4) bathrooms with three (3) bedrooms occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 120.4 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of nonperishable and 2 days of perishable foods. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced 08/26/2025. First aid kit was observed to be complete. Fire drill last conducted on 07/28/2025. Emergency disaster plan last updated 09/25/2024. Continues on LIC809C Continued from LIC809. Five (5) staff records were reviewed; all five (5) staff were associate. LPA also reviewed all five (5) resident records, and they were complete. LPA requested the following documents to be submitted to CCLD by 09/24/2025 . LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (last page) Liability Insurance Updated Facility Sketch LPA observed no deficiencies during visit. Exit interview conducted a copy of this report provided.