Routine inspection·April 14, 2026

Licensing Program Analyst (LPA) Evelin Rios arrived at the facility listed above to conduct an unannounced annual inspection. LPA was greeted by the Caregiver/Designee, Maria Ana Rodriguez. LPA signed in and checked their temperature on a thermometer affixed to the wall. In the facility LPA observed two (2) caregivers and six (6) residents. The Caregiver/Designee informed the Licensee, Anne Gregorio that LPA was at the facility. The administrator, Daisy Hailey and the licensee will not be able to meet with LPA today. LPA explained the reason for the visit. At 9:05 AM, LPA initiated a physical plant tour of the facility inside and out and the following was observed. LPA observed appropriate postings at the entry of the facility which included a facility sketch and LIC610E. The facility has an open concept space with the living room, dining area and kitchen . The areas were clean, clear of clutter and were properly furnished. The dining area had a table and chairs that sit the capacity of the facility. Living area had a television and seating for the capacity of the facility. LPA observed two carbon monoxide detector one by the entry and another in the hallway by bedroom #3 and #4. They were tested and observed functioning properly. The kitchen was observed to be clean and clear of clutter. Appliances and fixtures were functioning properly. LPA observed knives locked in a kitchen drawer. LPA observed a sufficient amount of 2-day perishable and 7-day non-perishable food. LPA observed one (1) fire extinguisher fully charged with a last serviced date of 05/08/2025. LPA inspected five (5) out of five (5) resident bedrooms . One (1) out of the five (5) bedrooms is a shared bedroom. LPA observed each resident room to be properly furnished with a bed, a night stand, one chair, bedding, sufficient lighting and storage. LPA opened exterior doors in all resident bedrooms and observed the auditory alarms were functional. (Continued on LIC809-C) (Continued from LIC809) LPA observed the doorways to room #3 with gaps on the flooring. The rugs used to cover the doorway to room #4 were observed lifted at the corners. The facility has three (3) bathrooms. One (1) bathroom is in the shared bedroom. Hot water temperature in two (2) bathrooms was measured, temperature was between 117°F and 118 °F, within regulation. LPA observed the bathrooms to be clean and properly supplied with toilet paper and hand soap. LPA also observed grab bars and non slip shower mats. The laundry room leading to the garage and staff bedrooms is kept locked and inaccessible to residents. Detergents are kept locked in the laundry room. In the backyard, LPA observed a covered patio and outdoor furniture for resident use. Passageways were clear of obstructions and there were no bodies of water observed. At 10:25 AM, LPA observed a caregiver test smoke detectors in the hallway, in bedroom #1, #3, #4 and #5. Detectors were observed to be functioning properly. At 10:32 AM LPA reviewed the register of facility residents (LIC9020) and the Personnel Report (LIC500). According to the Caregiver/Designee the LIC500 needed to be updated. LPA reviewed the Emergency Disaster Plan (LIC610E), Liability Insurance Certification and outdated emergency disaster drills. LPA was not provided documentation that an emergency disaster drill had been conducted in the last quarter. At 10:49 AM, LPA conducted a file review of six (6) of six (6) resident records to ensure compliance with licensing forms. Review of Resident#1 (R1's) Physician's Report (LIC602) notes their ambulatory status as nonambulatory. Review of the facility's approved Fire Inspection (STD850) and facility sketch shows Room #1 where R1 is residing is cleared for an ambulatory resident only. Review of Resident#2 (R2's) Pre-placement notes their ambulatory status as nonambulatory and Room #2 where R2 is residing is cleared for an ambulatory resident only. Facility had submitted a request to update ambulatory status in 2019 but LPA did not see evidence or was provided evidence from the licensee that it was processed. R2 has an admission date of 02/15/2026 without a medical assessment on record. Facility has a Hospice waiver for three (3) but currently based on resident records and staff interview four (4) residents are receiving Hospice services for a terminal illness. LPA reviewed medication and medication records for proper documentation. LPA conducted a file review of two (2) staff records to ensure compliance with licensing forms. Two (2) out two (2) staff have expired First Aid/CPR certification. Exit interview conducted. Deficiencies cited (refer to LIC809-D). Appeal rights explained and provided. Copy of report provided to the designee.