Routine inspection·November 17, 2025

On 11/17/2025 at 09:45 am Licensing Program Analyst (LPA) Lorena Casillas met with administrator Aldrin Perez for an unannounced one (1) year Required visit for this facility. LPA was greeted and granted access by Administrator. LPA explained the reason for the visit and an entrance interview was conducted. At 10:00 am LPA conducted a facility tour with the Administrator, and the following was observed. There are five (5) residents in the facility. Four (4) residents are non-ambulatory, none of which are in hospice care and one (1) resident is ambulatory. LPA observed all residents to be in their rooms watching TV or sleeping. Facility is cleared for six (6) non ambulatory residents of which three (3) can be bedridden and an approved hospice waiver for two (2) residents. Infection control: The facility has an Infection Control Plan approved on 03/30/2021. Proper signage was observed inside along the hallway and in the restrooms. Kitchen: LPA observed the kitchen to be clean and clear of clutter. All appliances were operative. Cleaning solutions are locked under the sink. Knives are kept locked in the garage and inaccessible to residents. LPA observed smoke alarms throughout the facility that are interconnected. At 10:20 a.m. all smoke alarms were tested and functioned properly. LPA observed one carbon monoxide detector, and it was tested and proved to be functioning. Bedrooms: There are five (5) bedrooms designated for resident use. One (1) out of the five (5) rooms is shared. All resident rooms are furnished with required lighting, dresser, chair, bed, and linens. Continued on LIC809-C Dining / Living Area: The dining and living area were well lit, clean, and clear of clutter. Furniture appeared clean and in good repair. A fireplace located in the living area is covered and not in use. LPA observed the thermostat at a comfortable temperature of 72°F. There is a fire extinguisher located near the main entrance, and it was last purchased on 11/25/2024. Bathrooms : There are two (2) bathrooms designated for resident use. One (1) bathroom is located in the shared bedroom, and the other main bathroom is accessible to all the residents. Both bathrooms were well lit and clean, had grab bars, hand washing signs, nonskid mats, and trash bins with lids. LPA observed a sufficient supply of hand soap and paper towels. Water temperature in the bathrooms was measured at 110.7˚ Fahrenheit. Laundry Room: LPA observed the laundry room to be locked and inaccessible to residents. Garage: LPA observed garage to be used for extra storage. There is a freezer stocked with appropriately labeled food. There is an additional supply of canned goods. Surrounding Grounds : There were no visible hazards, and passageways were free from obstruction. Side gates on either side of the house were closed but unlocked. There is a covered patio to provide shade and appropriate outdoor seating for residents. LPA observed two sheds in the backyard, one (1) for storage and another one (1) being used as an office. Administrative: Annual fee does not reflect current, however Administrator provided proof that payment was mailed on 11/06/25. L IC 500, Liability Insurance and Resident roster were collected. Staff Files : LPA conducted a file review of staff records at 11:30 am. Resident Files : LPA conducted a file review of resident records at 12:00 pm. Medications : At 2:00 pm LPA and Administrator reviewed medication and medication records for proper documentation. Staff/Resident Interviews : At 2:25 pm LPA interviewed staff and residents. No citations issued. Exit interview conducted and a copy of this report given to Administrator.