Routine inspection·February 5, 2026

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA was met by Romeo Casimiro and Evangeline Casimiro, Caregivers and explained the purpose of the visit. At 1:15pm, administrator, Lauri Gallegos arrived and and assisted LPA with the inspection. The facility is approved to serve residents age range 60 and over, (5) non ambulatory, (1) bedridden in bedroom #5, hospice waiver for (6). 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. LPA observed that the infection control plan did not show that the administrator/licensee reviewed the procedures in 2025, no date nor signature on the form. Bathroom has hygiene items such as paper towel, hand soap and toilet paper. Operational Requirements: A fire clearance is in place. Facility has working signal systems in exit points. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 02/01/2027. Fire drill was last conducted on 10/16/2025. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood which consists of (5) bedrooms, (4) of which are resident bedrooms, (1) staff bedroom, (3) bathrooms, living room with fireplace, kitchen, dining area, breakfast nook, laundry inside one of the bathrooms, attached garage and backyard with patio area. There are currently (6) residents, 60 years and older residing in the facility, (5) are under hospice care. 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. There are (2) fire extinguishers in the facility without proof of purchase provided. Smoke alarms and carbon monoxide were tested and operable. 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***** Staffing: A total of (6) caregivers including the Administrator provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have the required training and associated to the facility. Administrator's CPR/First aid certificate expired in Nov. 2025 and a valid certificate will be emailed to LPA. Personnel Records-Training: Five (5) staff files were reviewed for criminal background clearance and training. Personnel records have health/TB screenings. Administrator has completed the required Administrator courses and certificate is valid through 09/05/2026. Resident Rights-Information: Resident personal rights are posted. Facility provides internet services to all residents and have access to the facility phone. Administrator provides initial and ongoing training for staff. Planned Activities: Information regarding Dementia is part of training for direct care staff and is included in the Plan of Operation. The facility provides sufficient space to accommodate both indoor and outdoor activities. Food Service: The kitchen was inspected and has sufficient supply of 2 day perishable & 7 day non-perishable food. Pesticides and cleaning supplies are kept away from the food preparation areas. Modified diets for (3) residents are provided. Incidental Medical Services: Residents' medications were reviewed during the visit. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are stored in a locked cabinet and inaccessible to residents. However, LPA observed that the staff are pre pouring medications (2) days in advance in order to have them ready for the following shift. Resident Records-Incident Reports: Five (5) resident files were reviewed containing admission agreements, Physician's Report, Medical/Functional assessments, Needs and Services Plans, TB clearance, Personal rights, Medical Consent, Medication Records. Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan containing emergency evacuation, storage and preservation of medications, operation of manual assist devices. Administrator agreed to update the information on the temporary hotel location listed on the form. According to the administrator, they conduct emergency drill on a quarterly basis, however the last fire drill on file was conducted on 10/16/2025. Residents with SHN: (5) residents are under hospice care. Physician orders for bed rails were reviewed on the residents files'. No deficiency cited. Technical Violation and Technical Assistance issued. Exit interview and a copy of this report was provided to the Administrator, Laurie Gallegos.