Routine inspection·July 22, 2025

At 09:30 am, Licensing Program Analyst (LPA), Huma Rahimi conducted an unannounced annual inspection visit to the above facility and met with the Staff Florencio A. Aguilom. The staff contacted contacted the Licensee and LPA disclosed the reason for the visit. The Licensee arrived at 10:26 AM, to the facility. Today's site visit consisted of LPA touring the physical plant inside and outside and observed the following: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven, and a sink. Stove was observed in a good working condition. LPA observed adequate supplies of perishable and nonperishable food. All knives and sharps are observed to be locked in a kitchen cabinet and inaccessible to residents. Fire Extinguisher was last purchased on 05/26/2025 and was observed hanging on the wall in the kitchen. MEDICATION ROOM: LPA observed that the centrally stored medication are kept in the kitchen in a locked cabinet. Residents and staff files will be kept locked in a cabinet in the living room. LPA reviewed the medication and did not observe any discrepancies. BEDROOMS: There are four (4) bedrooms designated for resident’s use. All bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational. The facility does not have a live-in staff. The facility have an awake staff. Continue on LIC 809C BATHROOMS: LPA observed three (3) bathrooms at the facility of which two are attached with bedroom number (2) and (3). One of the bathrooms are in the main hallway which is used by visitors and staff. L PA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and had non-skid mat The water temperature was noted at 118.9°. LAUNDRY ROOM: The laundry room is located towards the end of the hallway. Laundry and other cleaning supplies are kept inaccessible in a cabinet in the laundry room. LPA observed the laundry room to be locked and inaccessible to residents in care. The washer/dryer appear to be in good working condition. COMMON AREAS: The facility maintains a comfortable temperature at 75°F. The living room and dining area appeared clean and were properly furnished and has a television. No obstructions and or tripping hazards throughout the facility. LPA observed a screened fireplace. SURROUNDING GROUNDS: The back of the facility has sufficient yard space. LPA did observe appropriate outdoor furniture in the front yard of the facility that can accommodate six (6) residents, LPA observe a covered shaded area for residents . There is no swimming pool or any bodies of water at the facility. The exit was free of any obstruction or hazard. The facility has an ADU unit and LPA observed to be locked and inaccessible to residents in care. Garage/Storage: LPA observed a parked vehicle in the garage and extra supplies (paints, some extra tables/furniture) stored. LPA observed the garage to be locked during the visit. SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 11:09 AM, they were tested and observed to be operational. Between 11:15 AM to 12:30 PM, LPA reviewed records of four (4) residents and three (3) staff files. Residents and staff were completed and updated. Administrative: LPA collected Certificate of Liability Insurance, and LIC500. No deficiency issued during today’s visit. Exit interview conducted and copy of this report signed and delivered.