Routine inspection·February 3, 2026

On February 3, 2026, Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced annual required visit using the CARE Inspection Tool. LPA was met by Hannah Gitau Caregiver and explained the purpose of the visit. The Administrator Lilian De Leon, subsequently joined to assist with inspection. The facility is licensed to serve (6) residents ages 60 and above. All rooms have fire clearance for bedridden residents. Approved hospice waiver for (6). Structure: This is a single-story home consisting of: four (4) resident bedrooms (Bedrooms #1, #2, #3 are single occupancy with full size beds Bedroom #4 is a shared room), one (1) staff room, two (2) bathrooms, one (1) living room, one (1) kitchen with dining area, outdoor shaded patio located in the back yard area, an attached garage along with washer and dryer located outside the garage. The front yard has adequate shaded area with seating and has an enclosed fence. Page 1 of 3 Physical Plant: LPA toured the physical plant with Caregiver, S1. There are no bodies of water or obstructions on the premises. A total of four (4) rooms were inspected. Bedrooms: LPA inspected all 4 bedrooms; the mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Bathroom s: Toilets and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries are accessible to residents. LPA tested hot water temperature, and it measured between 105- and 120-degrees Fahrenheit. This facility provides residents with hygiene products such as feminine napkins, non-medicated soap, toilet paper, toothbrush, toothpaste, and comb. Required Postings : LPA observed all required documents posted throughout the facility. The facility has a working landline telephone. Page 2 of 3 Kitchen LPA inspected the kitchen and observed all appliances to be in good working repair, including stove/oven, microwave, dishwasher, refrigerator. LPA observed an ample supply of cutlery, pots, pans, and bowls to be in good repair. LPA observed knives and additional sharps to be secured in locked cabinet in the kitchen and are inaccessible to residents. LPA observed a 2-day supply of perishable foods, and a 7-day supply of non-perishable foods properly stored, packaged, and labeled. Safety LPA observed 1 fully charged fire extinguishers. The last emergency drill was conducted on 12/8/25. Smoke detectors test and was operable File Review: LPA reviewed 3 resident files and found that 3 out of 3 had the required documents. LPA reviewed 3 staff files and found that 2 out 3 had the required documents, training, and certifications. LPA observed that 1 out 3 records not available for review. Medications LPA observed all centrally stored medications secured All medications were observed in their original packaging. LPA reviewed a copy of the facility’s Liability Insurance with expiration date of 1/27/27 Infection Control LPA observed required infection control signs posted throughout the facility. LPA observed sanitizing stations throughout the facility. LPA observed an ample supply of cleaning supplies Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. Facility maintains documentation of the required emergency drills. During today’s visit there were no deficiencies cited. 1 Technical Violation issued. An exit interview was conducted with Administrator Lilian De Leon Page 3 of 3