Post-licensing visit·April 8, 2026

On 04/08/2026 at 10:08AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct a post licensing inspection. LPA met with Domingo Bonifacio, Caregiver. Administrator, Christian Summers, arrived at approximately 10:35AM and LPA explained the purpose of the visit. The facility has a fire clearance for six (6) non-ambulatory residents and a hospice waiver for two (2) residents. LPA inspected the facility with Administrator including but not limited to the bedrooms, bathrooms, kitchen, common area, storage areas, and the backyard. LPA observed all bedrooms were equipped with required furniture for the comfort and safety of the residents. LPA observed grab bars in shared residents’ bathrooms. Hallways and passages are free of obstruction. Hygiene supplies and toiletries were available. Facility temperature is maintained at 72 degrees F. Hot water temperature measures 114.4 degrees F. in residents shared bathroom. Fire extinguishers were last serviced on 08/06/2025. First aid kit was complete with manual. Carbon monoxide and smoke detectors were observed operational during visit. Facility inspection matches the sketch that was provided. Continue on LIC809C….. Continued from LIC809 LPA reviewed three (3) residents records, and three (3) staff records. LPA also reviewed the medication and Medication Administration Record (MAR) during visit. The following documents were requested for facility file and are to be submitted to CCLD by 04/16/2026 : LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan LIC9020 Resident roster Liability Insurance Current Administrator’s Certificate Updated facility sketch No deficiencies were cited during vis i t. Exit interview conducted, a copy of this report and LIC9102TV provided to Christian.