Routine inspection·February 4, 2026

On 02/04/2026 at 12:15 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Elizabeth Ulloa, and explained the purpose of the visit. Elizabeth phoned, Licensee/Administrator, Rahab Mungai to inform and Ms. Mungai arrived soon after. The facility’s fire clearance was approved for capacity six (6) residents in which all may be non-ambulatory. Inn addition, there is approval for one (1) bedridden in bedroom #5 and hospice waiver approved for six (6) residents. Administrator certificate # #6070960740 expires 12/05/2026. LPA toured facility with Rahab including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of five (5) total bedrooms which all five (5) bedrooms are occupied by the residents. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 107.6 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one-week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. LIC809-C Continued... LIC809-C (Page 2) Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 03/03/2025. Emergency Disaster Plan was last posted on 02/04/2026. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 12/03/2025. LPA reviewed 6 (six) residents records. LPA reviewed 5 (five) staff records and all staff have current first aid training and associated to the facility. LPA reviewed a sample of resident’s medications. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 02/11/2026: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report Updated LIC 610E Emergency Disaster Plan Copy of Liability Insurance Current Administrator’s Certificate - Reviewed No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.