Routine inspection·January 5, 2026

At 9:45 AM, Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection at the facility mentioned above. LPA met with the staff #1 (S1) Cirila De La Cruz and staff #2 (S2) Emmanuel Lima and the Administrator Florence Perigrino was contacted via a telephone. LPA explained the reason for the visit. The Administrator informed LPA that they are unable to come to the facility; however, designated the staff to conducted today's visit. The physical tour was conducted with the staff and LPA observed the following: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven, sink. Stove was observed in a good working condition. LPA observed adequate supplies of nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps were observed to be unlocked in a kitchen cabinet and accessible to residents. LPA was informed that all sharps are kept unlocked all the times and the staff was never told to keep the knives locked. LPA also observed cleaning supplies, a screw driver, and a hammer unlocked in the kitchen cabinet and accessible to residents in care. A Fire Extinguisher was last purchased hanging on the wall in the by between the kitchen and laundry area. It was purchased on 10/04/2025. Medication: The medications for staff and residents were observed in the kitchen drawer and cabinet and LPA observed that staff and residents medications are unlocked and accessible to residents in care. The staff informed LPA that the medications always remain unlocked. LPA observed medications in the staff room and the staff room was observed unlocked and accessible to residents in care. More medications were observed unlocked in bedroom #3. Continue on LIC809-C BEDROOMS: There are four (4) bedrooms designated for residents use. All bedrooms have sufficient closet space and have sufficient lighting. All bedrooms were observed to be properly furnished with appropriate beddings and linens. Facility has a live-in staff at the facility. The designated bedroom for the staff is bedroom (1); however, the staff is currently using bedroom #4. LPA observed room #4 unlocked and accessible to residents in care with their prescribed medication unlocked. In bedroom #3 LPA observed a scissor and resident's medication accessible and unlocked to residents in care. LPA also observed the emergency exit being blocked by a trash can and a basket. BATHROOMS: There are total of three (3) bathrooms and LPA observed all bathrooms to be clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed bathroom to have appropriate grab bar and a non-skid mat . The water temperature was noted at 125.4°. The facility is using one of the bathrooms attached with bedroom #1 for staff and visitors only. COMMON AREAS: LPA observed all common areas to be clean in good repair. The facility maintains a comfortable temperature at 70°F. The living room and dinning rooms were properly furnished. No obstructions and or tripping hazards throughout the facility. LAUNDRY ROOM: The laundry room is located behind the kitchen which has an entry to garage. LPA observed a door with a lock; however, it was observed unlocked with all laundry detergents unlocked and accessible to residents in care. The washer/dryer appear to be in good condition. SURROUNDING GROUNDS: The back of the facility has sufficient yard space. LPA observed appropriate outdoor furniture, LPA observe a covered shaded area for residents . There is no swimming pool or bodies of water in the facility. One of the main exits in the activity room of the facility which leads to the main emergency exit of the facility was observed locked and inaccessible due to a dog. The Administrator informed LPA via a telephone that none of the staff or residents are allowed to use that exit. The exit was obstructed and blocked by a dog. Continue on LIC 809C SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. They were tested and observed to be operational. Activity Room: LPA observed an activity room for residents use with an adequate amount of activities. The activity room is located in the back of the house adjacent to living and dinning rooms. Records: Upon request of the staff and residents records/facility files, LPA was only provided with partial records for Resident #1 (R1) and LPA reviewed two other residents files and observed only the admission agreement and ID information for R2 and for R3 only an admission agreement on file. Moreover, LPA was informed the S1 have been working at this facility since 10/22/2025 and S2 is working since December of 2025. However, LPA reviewed LIS and Guardian and did not observe S1 being associated and S2 being finger print cleared and associated with the facility. LPA also did not observe any staff training records and LPA was informed that no staff training are conducted. Additionally, LPA observed that Resident #1 (R1) was taken to the hospital on 10/07/2025 and again on 10/22/2025 through 10/31/2025 for urinary tract infection; however, no incident reports were submitted to Community Care Licensing Division (CCLD) in a timely manner. LPA reviewed all incident reports on a system and did not observe an Incident Report regarding R1. In addition, the Administrator admitted that no incident was submitted to the Regional Office (RO). Based on Title 22 Regulation: a written Unusual Incident / Injury Report shall be submitted to CCLD within seven (7) days of occurrence. LPA informed the Administrator that all staff members are mandated reporters and they are all responsible for reporting. Administrative: LPA collected liability insurance certificate. During today's inspection, the facility is not in compliance with Title 22 regulations. Deficiencies will be cited for today's visit. Appeal rights explained Exit interview conducted. Copy of report provided.