Routine inspection·September 11, 2025

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required-1 year visit. LPA was met by Raquel Salen and Zenaida Gomez, Care Staff and explained the purpose of the visit. At 2:20pm, Administrator Elna Villaflor arrived and assisted LPA. The facility is licensed to care for (6) non ambulatory residents ages 60 and above and one may be bedridden. Bedridden fire clearance approved for bedroom #1 only. Approved to care for (6) hospice residents . LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. Bathroom has hygiene items such as paper towel, hand soap and toilet paper. Staff are using appropriate hand hygiene and wearing gloves while assisting residents. Operational Requirements: A fire clearance is in place. Facility has working signal systems in exit points. Liability Insurance policy is valid and will expire on 04/02/2026. LPA observed that the fire extinguisher in the kitchen was not secured/mounted on the wall as required. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood that consists of (4) resident b edrooms, (1) staff bedroom, (2) bathrooms, living room with a covered fireplace, kitchen, dining area, den, laundry area in the hallway, backyard with shaded patio area and attached garage. Currently, there are five (5) residents in the facility. The interior and exterior physical plant was inspected. Resident bedrooms were toured. Each bedroom has a smoke detector, linen, light, chair and sufficient closet space. Backyard was inspected and has a shaded area and sitting area. There is (1) fire extinguisher in the facility which was last serviced on 07/10/2025. There is a carbon monoxide detector in the hallway and smoke detectors are interconnected. There are no firearms or weapons stored at the facility. Water temperature reading measured within the required 105 - 120 degrees Fahrenheit. *****REPORT CONTINUED ON LIC809-C**** Residents with SHN : LPA observed an unsecured oxygen tank lying on the floor in the attached garage. Due to time constraints, LPA has to continue the annual inspection at a later date. LPA has to complete the following domains: Staffing, Personnel Records/Staff Training, Resident Rights-Information, Planned Activities, Food Service, Incidental Medical Services, Resident Records-Incident Reports, Disaster Preparedness and Residents with SHN. Technical Violation and Technical Assistance were issued. Exit interview conducted and a copy of this report was provided to the Administrator, Elna Villaflo r.