Routine inspection·November 3, 2025

Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced one (1) year inspection at this facility. LPA met with Administrators and explained the reason for the visit. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: At 11:00 AM. LPA and Administrator conducted a physical plant tour of the facility. The facility has one main entrance being used. Required posting are observed to be complete, current and displayed properly. The facility has an approved mitigation and infection control plan on file. The facility is a two story home in a residential community. It consists of five (5) bedrooms and two (2) bathrooms, kitchen, laundry room, covered patio and detached ADU. Two (2) bedrooms are double occupancy and two (2) bedrooms are single occupancy designated for residents, and one (1) bedroom on the second floor is designated for staff use. The facility is licensed to serve (6) residents ages 60 and above of which (6) may be bedridden. Facility has an approved hospice waiver for (6) residents. Smoke detectors and carbon monoxide were tested for proper function. Fire extinguishers were last serviced on 05/22/2025 and observed fully charged. The most recent disaster drill was conducted on 01/08/2025. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors were inspected. They were found clean and good repair. The facility maintains a comfortable temperature at 71°F. Living Room furniture was checked. Furniture in the living rooms was observed in good repair, clean and free of hazards. It was appropriately furnished and provided a comfortable environment for residents. Resident bedrooms are adequately furnished with appropriate furniture and lighting system. Cont. on LIC 809-C Hallways/passageways are lit. Residents have sufficient amounts of personal hygiene products which are provided by the Administrator. Bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet and shower. The hot water temperature measured at a range of 113.4°F to 113.5°F. Towels and washcloths are not shared. There are enough clean linen available in stock in the linen cabinet located in the hallway. Food Service / Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Food storage and preparation areas are clean. The kitchen appeared clean and the appliances and fixtures functional. Knives and sharps are observed to be kept in the laundry room cabinet locked and inaccessible to residents. Medications : LPA observed medication in the laundry room locked cabinet locked and inaccessible to residents. First Aid kits are observed to be with complete tools and supplies. Laundry room is located adjacent to the kitchen and was observed to be locked and inaccessible to residents. Cleaning agents, toxins and detergents were secured. Accessory Dwelling Units (ADUs) is detached, locked, and inaccessible to residents. The front yard of the facility has outdoor furniture, with a shaded area covered available for residents. The front and backyard passageways were clear of any obstruction. There is no body of water at the facility. Staff records were reviewed. Staff present had criminal record clearances and associated to facility. Staff records appear to be complete and current. Resident records were reviewed. Resident’s records appeared to be complete and current. There is no health and safety issue observed during this visit. Exit interview conducted. A copy of this report provided.