Routine inspection·December 16, 2025

On 12/16/2025 at 1:40 p.m., Licensing Program Analyst (LPA) Evelin Rios arrived to this facility to conduct an unannounced, annual inspection. LPA was greeted by Staff #1(S1), who granted access. S1 contacted the administrator, Marita Amorsolo-Samaniego. Another staff, Staff #2 (S2) was observed by LPA in the facility assisting residents. The administrator and designee, Tatiana Buendia arrived shortly after. The administrator could not stay for the duration of the visit and designated, Tatiana to sign todays report. By the entrance LPA observed that the facility had required postings, which include but are not limited to the Complaint Poster, Long-Term Care Ombudsman information, and Residents' Rights. At approximately 2:00 p.m., LPA conducted an inspection of the facility inside and out and the following was observed: Common Areas : These include the sitting area at the front of the facility, and the living/dining area. The sitting area, living/dining area were clean and clear of clutter, furnished appropriately and sit the capacity of the facility. The furniture was observed to be in good repair. Bedrooms: There are five (5) bedrooms designated for residents. One (1) bedroom is shared. LPA observed each resident room to be properly furnished and have sufficient storage. Exit doors had auditory alarms that were on and observed functioning. The facility is equipped with hardwired smoke and carbon monoxide detectors through out the facility. LPA observed S2 test detectors at approximately 2:11 p.m. and were observed to be functioning. (Continued on LIC809-C) (Continued from LIC809) Bathrooms: The facility has three (3) bathrooms, two of which are designated for resident use, and one is located in the shared bedroom for private use. Bathrooms were properly supplied with hand soap, toilet paper and paper towels. Hot water temperature in the bathrooms were tested at 2:16 p.m. and measured around 116.8 degrees Fahrenheit. Laundry Room : The laundry room was observed locked. Cleaning supplies and detergents were observed locked in cabinets in the laundry room. Kitchen: The kitchen was observed clean and clear of clutter. Fixtures and appliances were observed functional. LPA observed a sufficient amount of 2-days perishable and 7-days non-perishable food in the facility. Food was observed stored in covered containers at appropriate temperatures. Knives were observed locked in a kitchen drawer. Centrally stored medication was observed locked in a kitchen cabinet. A fully charged fire extinguisher was observed on a kitchen wall with purchase date 03/19/2024. LPA observed a fully stocked first aid kit and manual accessible to staff in the kitchen. Surrounding Grounds : Backyard space was large enough for outdoor activities. The backyard is fully fenced in and no hazards observed. No body of waters observed. Client/Staff Records: At approximately 3:00 p.m., LPA reviewed the facility’s file, as well as resident and staff records, to assess compliance with required licensing documentation. Facility’s file, included the but not limited to, resident roster, personnel report, liability insurance certificate, emergency and disaster plans, and documentation of emergency drills conducted by the facility. At approximately 3:17 p.m., LPA reviewed five (5) resident records and three (3) staff records. During the review of Resident #1’s (R1) Physician’s Report, LPA observed that TB test results were not documented. According to designee the facility is awaiting a mobile lab to schedule an in-home TB test for R1. No documentation of TB test results was found in R1’s file at the time of the visit. Deficiency observed during the visit (refer to LIC809-D). Appeal Rights Provided. Exit Interview conducted. A copy of the report issued.