Routine inspection·November 19, 2025

Licensing Program Analyst (LPA) Jose Tan, met with staff Flora and Domingo Calderon for a One (1) year required visit for this facility. Staff called the administrator Mary Jane Rivera who arrived at the facility twenty (20) minutes later. LPA explained the reason for the visit. A tour of the physical plant was conducted at 9:13 AM and the following was noted: There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room. The facility has four (4) bedrooms and three (3) bathrooms currently occupying six (6) residents. One (1) bedroom and one (1) bathroom is designated for staff use. The facility is licensed to care for six (6) non-ambulatory resident and hospice waiver for six (6) residents. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with the dining room. The facility maintains a comfortable temperature at 76°F. The smoke detectors were tested and observed to be operational. There is a fire extinguisher located in the kitchen and was observed to be full and last serviced on 03/28/25. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. There is a locked shed being used as a used equipment storage. The garage is attached to the house but has no access from inside the house. It is also being used as laundry area, storage for frozen foods and old equipment. All the laundry detergents, cleaning solutions, toxins and other chemicals are observed to be locked in a cabinet and inaccessible to residents. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days of non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. All sharps and knives were also observed to be locked in the kitchen cabinet below the sink. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. Staff Rooms: Staff room was locked. No medications are observed in the staff room. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. Sink in the bathrooms were removed and under construction. The hot water temperature measured at 107.4°F. Towels and washcloths are not shared. There is enough clean linen available in stock at the cabinet. Medications : LPA observed medication in the living room cabinet to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. There is a complete first aid kit located in the medication cabinet. Client records : Client records are reviewed. all residents' file appeared to be complete and updated. One (1) resident however is bedridden and the facility has no bedridden fire clearance. Staff records : LPA conducted a complete file review of staff records. Staff records observed to be complete and updated. Disaster drill was last conducted on 10/28/25. Required posting are observed to be complete and current and displayed properly at the facility. Exit interview conducted and copy of this report issued.