Routine inspection·March 3, 2025

On 3/03/2025 at approximately 10:00 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by the caregiver and LPA stated the reason for their visit. Administrator, Roilann De Guzman arrived shortly after to assist with today’s visit. LPA asked for the census, Staff/Resident Roster, and liability Insurance. LPA conducted a physical plant tour at approximately 11:00 AM and the following was noted: The facility is a single unit building with six (6) bedrooms and two (2) bathrooms currently occupying five (5) residents. There is no designated staff room inside the facility. The facility has an approved fire clearance for six (6) non-ambulatory residents of which three (3) may be bedridden. The facility has a hospice waiver approved for six (6) residents. The infectious disease screening area is located immediately upon entry. Sign in sheet, hand sanitizer, gloves and masks are available. Common areas: Living room and dining room were observed to be neat, clean, and organized. Both rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 73°F. A fire extinguisher is located in the kitchen and dated 09/09/24. Required postings such as See/Say Something, Facility License, and Resident’s Rights are located immediately upon entry. A fireplace was observed to be covered and inaccessible to residents. A working telephone was observed. Kitchen: Kitchen observed to be clean and inaccessible free from pests. Sufficient supplies of seven (7) day nonperishable food and two (2) day perishable foods were observed. Knives and sharps observed to be locked in kitchen drawer. Cleaning solutions and disinfectants observed to be kept in a locked cabinet underneath kitchen sink. Kitchen appliances observed to be working and in proper condition. Bedrooms: The Residents' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. Extra linens/covers were observed stored in a storage closet located in the hallway’s passageway. (continued on LIC 809-C) Bathrooms: Bathrooms were checked for cleanliness and proper operation. Appropriate grab rails and non-slip mats were observed and in proper condition. The hot water temperature was measured within regulations at 111.9°F. Garage: There is no designated garage. Laundry Room: The laundry room is located in a separate room outside of the facility, near the entrance. The laundry room is kept was observed locked and inaccessible. LPA observed cleaning solutions and toxins properly stored within laundry room and inaccessible to residents. Laundry appliances observed to be working and in proper condition. Backyard: The backyard of the facility is equipped with a designated shaded area with outdoor furniture for residents. LPA observed a pool properly fenced and locked. Medications: Medication were observed kept stored in a locked medication cart located near the dining area. First-aid kit observed to be equipped with but not limited to bandages, scissors, digital thermometer, tweezer, and First Aid manual. Smoke detectors and carbon monoxide observed to be working properly and were tested. The Last Fire Drill was conducted on 3/01/25. Resident/Staff Records: LPA conducted a complete file review of resident records. Resident records appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated. There was no immediate health and safety hazard observed during the day of inspection. Exit interview conducted and a copy of this report was provided to the Administrator.