Routine inspection·September 14, 2025

On September 15, Licensing Program Analyst (LPA), Deborah Lee conducted an unannounced annual required visit using the CARE Inspection Tool. LPA Lee met with Jun Fausto Figueroa and the purpose of today’s visit was explained. This facility is licensed to serve 6 non-ambulatory residence over 60 years old. A total of 6 residents are currently residing in this facility. There is a hospice waiver for 6. Physical Plant/Structure : The facility is a single-story home located in a residential neighborhood. The entry way of the home is clear and free of debris and obstruction. The home has dual entry doors that open into a foyer. There are 5 resident bedrooms, 3 1/2 bathrooms, dining room, living room, laundry room off of kitchen area. There is an attached garage. The facility has a pool that is gated with required locking on the gate. According to licensee, the pool will not be accessible to residents, as it is a "show piece" feature of the house. Bedrooms: LPA inspected all 5 bedrooms; the mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Page 1 of 3 Bathroom s: Toilets and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries are accessible to residents. LPA tested hot water temperature, and it measured between 105 and 120 degrees Fahrenheit. This facility provides residents with hygiene products such as non-medicated soap, toilet paper, toothbrush, toothpaste shampoos, lotions. Common Rooms: The living room is fully furnished with sofa, 2 chairs, coffee table, 3 recliners and mounted TV. There is adequate space for activities. Required Postings: LPA observed all required documents posted throughout the facility. The facility has a working landline telephone. Kitchen LPA inspected the kitchen and observed all appliances to be in good working repair, including stove/oven, microwave, dishwasher, refrigerator. LPA observed an ample supply of cutlery, pots, pans, and bowls to be in good repair. LPA observed knives and additional sharps to be secured in garage area and are inaccessible to residents. LPA observed a 2-day supply of perishable foods, and a 7-day supply of non-perishable foods properly stored, packaged, and labeled. First aid kit is fully stocked with the required items and a manual. Page 2 of 3 Safety LPA observed 2 charged fire extinguishers last serviced on 7/3/24 The last emergency drill was conducted on 5/14/2025. Smoke detectors were tested and operable. File Review: LPA reviewed 6 resident files and found that 6 out of 6 had the required documents. LPA reviewed 3 staff files and found that 3 out 3 had the required documents, training, and certifications. LPA reviewed a copy of the facility’s Liability Insurance with expiration date of 9/25/26 Medications LPA observed all centrally stored medications secured All medications were observed in their original packaging. Infection Control LPA observed required infection control signs posted throughout the facility. LPA observed sanitizing station in the entry way of facility. LPA observed an ample supply of PPE on hand for use when needed. Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. Facility maintains documentation of the required emergency drills. Emergency Intervention: Clients at this facility do not need the use of restraints or de-escalation techniques. During today’s visit there were no deficiencies. An exit interview was conducted with Jun Faust Figueroa and a copy of this report was provided. Page 3 of 3