Routine inspection·October 4, 2025

On October 4, 2025, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with caregiver Lyann Yu. Yu contacted the administrator and explained the purpose of today’s visit. The facility is licensed to operate for six (6) non-ambulatory of which (1) maybe bedridden elderly residents ages 60 and above. The facility is approved for (3) hospice residents. Currently, the facility has (3) residents in hospice care. The facility is a single-story home consisting of: (6) resident bedrooms, (3) Full bathrooms, (1) staff bedroom, living room, kitchen, dining room, laundry room (located in the attached garage), garage and an outdoor shaded patio area. LPA toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 105.1 F. A comfortable temperature of 69.0 degrees was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Fire extinguishers were charged, smoke detectors and carbon monoxide were operable. (Evaluation Report continues LIC 809-C) A review of the Medication Administration Record (MAR) was complete and accurate. The facility has conducted a disaster drill on 09/15/25. A landline telephone was in working condition. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. All mandated inspection control posters were posted. LPA observed First Aid Kit along with an American Red Cross First Aid Manual was maintained. The facility is current on Community Care Licensing annual dues. The facility has a current liability insurance with policy # 00123055-3 effective 10/15/24 through 10/15/25. An audit of residents #1-#5 (R1-R5) service files and staff #1-#6 (S1-S6) personnel files were in order and complete. The facility has the current administrator's certification on file for Jehn Maric Demafelix Administrator's Certificate #7021644740 effective 01/30/24 through 01/30/26. Deficiencies: At 11:50 AM LPA identified smoke detector for Resident #3's bedroom non-operational. Staff #1 through Staff #6 all did not have current CPR/First Aid Certificate on file. Resident #3 did not have TB test results on file. An exit interview was conducted with Lyann Yu , and a copy of the report was provided. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) are cleared. *