Routine inspection·October 7, 2025

Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced Annual Inspection. Upon arrival LPA was greeted by Staff #1(S1) who granted access. LPA contacted the Administrator, Natividad Arayata and explained the purpose of the visit. The Administrator Designee, Marti Natividad arrived shortly after. LPA observed appropriate postings through out the facility. At 2:38 p.m., the Administrator arrived to the facility. At 2:15 p.m., LPA initiated a physical plant tour of the facility inside and out and observed the following. Bedrooms: There are five (5) resident designated bedrooms of which one (1) is shared. All bedrooms have the proper furniture and adequate lighting. The auditory alarms on each exit door were tested and found to be operational. LPA observed the Administrator Designee test the Smoke and Carbon Monoxide detectors at 2:23 p.m., and they were functioning properly. LPA observed a fire door close for room labeled #1. Bathrooms: There are three (3) bathrooms designated for residents. One (1) bathroom is located in the shared bedroom. Each bathroom is equipped with grab bars and non-slip mats. The hot water temperature was taken at 2:26 p.m., from one (1) bathroom and read 113.2 degrees Fahrenheit within regulation. Common Areas: These include the living room and dining areas. Areas were clean and clear of clutter and the furniture was observed to be in good repair. (Continued. to LIC809-C) Laundry room/Garage: Laundry room is kept locked. Chemicals such as laundry detergents are also locked and stored above the washer and dryer. The garage is attached and access to the garage is through the laundry room. Garage is used to store furniture, facility supplies, and has a deep freezer for extra food. Kitchen: The kitchen was observed clean and clean of clutter. Knives and sharps are locked in a kitchen drawer inaccessible to residents. Chemicals for cleaning are locked and stored underneath the sink. LPA observed that the facility had a sufficient amount of perishable and nonperishable foods. Fire extinguisher was observed fully charged with purchase date 09/04/25. Outside: LPA toured the outside area and observed appropriate outdoor furniture with a shaded covered area for residents. There are no bodies of water. The surrounding grounds were clean, and free from obstructions. Facility has one shed outside that is maintained locked used for additional storage. Facility/Staff Files : At 3:02 p.m., LPA reviewed the facility's personnel schedule (LIC500), client roster, Certificate of Liability Insurance, and Emergency Disaster Plan. LPA reviewed four (4) staff records to insure forms and training are up to date and in compliance with licensing forms. Resident Files: At 3:30 p.m. LPA reviewed five (5) of five (5) resident records to insure compliance of licensing forms. Medication: Medication is centrally stored in the kitchen and was observed locked. At 4:10 p.m. LPA and Administrator reviewed medication and medication records. LPA observed a fully supplied first aid kit with manual. No deficiencies observed on todays visit. Exit interview conducted. A copy of this report provided.