Routine inspection·November 6, 2025

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual visit using the Compliance and Regulatory Enforcement (CARE) Tool. LPA was greeted by Katherine Pavon, Administrator explained the reason for the visit. This home is licensed to serve 6 residents ages range 60 and over, six (6) non-ambulatory of which one (1) may be bedridden. Facility has a hospice waiver for six (6) residents. There were two (2) residents under hospice care during inspection. Facility Tour & Observations Personal Rights postings (LIC 613C and Ombudsman), Complaint Poster (PUB 475), and nondiscrimination notice were observed in a common area. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present. “No smoking - Oxygen in Use signs” in various locations of the facility. Physical Plant The facility is in a residential area and is a one-story home consisting of four (4) resident bedrooms, two (2) bathrooms, living room, kitchen, dining area, attached garage, front yard, and backyard. Each resident bedroom contained the required furniture (bed, mattress, linens, dresser, chair, and lighting). Cleaning supplies and toxic substances are inaccessible to residents locked in garage cabinets. (Continued on LIC809C) LPA observed a Hoyer lift in the garage, per administrator used only when needed. Bathrooms were clean and equipped with required grab bars in showers and near toilets, as well as non-skid mats; hot water measured in bathroom (1) 107.6°F and bathroom (2) 105.9°F which is within the required 105–120°F. Extra linens and towels were available in hallway cabinets. Smoke/carbon monoxide detectors were functional, fire extinguisher was available in kitchen, and no bodies of water were present. Backyard provided shaded seating. Passageways and exits were observed to be clear and unobstructed. Food Service Refrigerators/freezers were maintained at proper temperatures (refrigerators maximum of 40 degrees °F and freezer 0-degree °C) with sufficient supply of 2-day perishable and 7 days non-perishable food. Fresh produce, proteins, and dry goods were stocked. Knives and were observed in a locked kitchen drawer. Health-Related Services & Records Five (5) residents files were reviewed and contained current required documents Admissions Agreements, Pre-Placement Appraisals, Consents, Needs/Service Plans, Physician’s Reports with TB/ambulatory status and Rights acknowledgments. Five (5) residents’ medications were reviewed; medications were observed to be centrally stored in a locked kitchen cabinet. MAR logs were observed to be current. Disaster Preparedness Last fire/earthquake drill was conducted on September 3, 2025, with logs available. LIC 610D Emergency Disaster Plan was posted in kitchen bulletin board. Emergency supplies (water, food, flashlights, batteries, first aid) were observed in the garage. Infection Control Plan was updated. Personnel Records & Training Three (3) staff files were reviewed and included criminal record clearances, CPR/First Aid, required training and TB screenings. Administrator Certificate for Katherine Pavon was valid through June 2, 2027. Insurance Liability insurance was in compliance with an expiration date of May 11, 2026. An exit interview was conducted with the Administrator Katherine Pavon. During the inspection, the facility was observed to be following Title 22, Division 6 regulations. No deficiencies were cited at this time. A copy of the report was provided.