Routine inspection·September 8, 2025

At 10:50 AM Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection visit at the facility mentioned above. LPA met with the staff Crismund Bayno Comendador. Staff contacted the Administrator and the Administrator arrived shortly after. LPA explained the reason for the visit. Physical tour was conducted with the Administrator and LPA observed the following: This is a single-story property. Fire Clearance is approved for six (06) non-ambulatory of which one (01) may be bedridden. Facility has five (05) bedrooms and three (03) full bathrooms. One (01) out of five (05) bedrooms is semi-private and the remaining are all private single occupancy. Kitchen: At approximately, 11:00 AM LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps observed to be locked in a kitchen cabinet. There is a fully charged fire extinguisher located by the kitchen area. The fire extinguisher was purchased on 04/26/2025. Medications: At approximately, 11:05 AM LPA observed medications are centrally stored in the hallway cabinet. LPA observed that the centrally stored medication cabinet locked and inaccessible to residents in care. Bedrooms: LPA observed total of five (5) bedrooms designated for resident’s use. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Facility has awake staff. Continue on LIC809-C Bathrooms: LPA observed three (3) bathrooms of which one is designated for staff and visitors and two (2) for resident use only. Resident bathrooms appeared to be clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and residents' bathroom had non-skid mat. LPA observed appropriate hand washing signs posted in each bathroom. Hot water temperature measured at 106.5°F. Common Areas : The facility maintains a comfortable temperature at 78°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions or tripping hazards throughout the facility. The garage is being used as a staff room and LPA observed to be locked and inaccessible to residents in care. Laundry room is outside by the main entrance of the facility and LPA observed being locked with the laundry detergents. Smoke detectors/carbon monoxide . Smoke detectors were located throughout the facility, and at 11:25 AM they were tested and observed to be operational. Carbon monoxide was located in a hallway and was also tested and observed to be operational. Outside areas: At approximately, 11:35 AM LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There is one emergency exit which was observed to be free of obstruction and hazard. Between 11:45 AM to 1:30 PM, LPA reviewed records of four (4) residents and two (2) staff. Resident and staff records appeared to be complete and updated. Administrative: LPA collected Certificate of Liability Insurance, and LIC500. No Deficiency cited during today’s visit. Exit interview conducted and copy of this report signed and delivered.