Routine inspection·February 10, 2026

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA was met by Nelia Macasinag, Caregiver and explained the purpose of the visit. At 10:50am, administrator, Elna Villaflor arrived and and assisted LPA with the inspection. The facility is approved to serve residents age range 60 and over, (6) non ambulatory, hospice waiver approved for (6) residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. Staff are trained in the proper use of all required PPEs. Bathroom has hygiene items such as paper towel, hand soap and toilet paper. Operational Requirements: A fire clearance is in place. Plan of operation and training logs were reviewed. The facility accepts and retains residents with dementia. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 04/02/2026. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood which consists of (5) bedrooms, (4) of which are resident bedrooms, (1) staff bedroom, (2) bathrooms, living room, formal dining room, family room with fireplace, dining area for residents, kitchen, laundry area, attached garage, and backyard with patio area. LPA observed a stand alone shed converted into a sleeping room for staff. There are currently (3) residents, 60 years and older residing in the facility, (1) is under hospice care. The interior and exterior physical plant was inspected. Resident bedrooms were toured. Each bedroom has a bed, linen, light, chair and sufficient closet space. Backyard was inspected. All outdoor and indoor passageways are kept free of obstruction. There are (2) fire extinguishers in the facility purchased on 12/21/2025. There are smoke detectors located in each bedroom and a carbon monoxide detector located in the hallway. There are no firearms or weapons stored at the facility. The hot water temperature was measured between the required range of 105-120 degrees F. *****REPORT CONTINUED ON LIC809-C***** Staffing: A total of (9) caregivers including the Administrator provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have the required training and associated to the facility. Personnel Records-Training: Four (4) staff files were reviewed for criminal background clearance and training. Personnel records have health/TB screenings. Administrator has completed the required administrator courses and certificate is valid through 06/05/2026. Resident Rights-Information: Resident personal rights are posted. Facility provides internet services to all residents and have access to the facility phone. Administrator provides initial and ongoing training for staff. Planned Activities: Information regarding Dementia is part of training for direct care staff and is included in the Plan of Operation. The facility provides sufficient space to accommodate both indoor and outdoor activities. Food Service: The kitchen was inspected and has sufficient supply of 2 day perishable & 7 day non-perishable food. Pesticides and cleaning supplies are kept away from the food preparation areas. No resident requires modified diet. Incidental Medical Services: Residents' medications were reviewed during the visit. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are stored in a locked cabinet and inaccessible to residents. Resident Records-Incident Reports: Three (3) resident files were reviewed containing admission agreements, Physician's Report, Medical/Functional assessments, Needs and Services Plans, TB clearance, Personal rights, Medical Consent, Medication Records. Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan containing emergency evacuation, storage and preservation of medications, operation of manual assist devices. Fire and earthquake drill was last conducted on 01/15/2026. Residents with SHN: (1) resident is under hospice care. Physician order for full bed rail was reviewed on the resident's file. There are no residents utilizing oxygen at this time. No deficiency cited. Technical Assistance issued. Exit interview and a copy of this report was provided to the Administrator, Elna Villaflor.