Routine inspection·January 28, 2026

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual visit using the Compliance and Regulatory Enforcement (CARE) Tool. LPA was greeted by Ana Aparicio and explained the reason for the visit. Maxson Raharuhi, Assistant Administrator arrived shortly thereafter. The facility is licensed to serve residents ages sixty (60) and older. The approved capacity is six (6) non-ambulatory residents. The facility is approved to retain no more than two (2) residents receiving hospice care. 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. Oxygen was observed in use in the facility. Required “Oxygen in Use / No Smoking” signs were posted throughout the facility in visible locations. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present. Physical Plant The facility is in a residential area and is a one-story home consisting of four (4) resident bedrooms, one (2) restroom one being a guest restroom, living room, kitchen, laundry room, dining area, laundry room, garage, front yard, and backyard. Property includes a caregiver corridor near bedroom four (4). LPA observed four (4) resident bedrooms, and all contained the required furniture (bed, mattress, linens, dresser, chair, and lighting). Cleaning supplies and toxic substances were accessible to residents in a kitchen cabinet under sink. (continued on 809C) 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) 113.2°F, bathroom (2) 111.5°F which is within the required 105–120°F. Extra linens and towels were available in a hallway cabinet. Smoke/carbon monoxide detectors were functional; fire extinguisher mounted in the kitchen. There were no bodies of water 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, ambulatory status and Rights acknowledgments. R1 and R2 were missing TB screenings. Five (5) residents’ medications were reviewed; medications were observed to be centrally stored in a locked cabinet in laundry room. It was observed that R1 and R3 require assistance from staff with administration of injectable medications. Additionally, R1 did not have Albuterol medication available. Disaster Preparedness Last fire/earthquake drill was conducted on January 27, 2026, with logs available. LIC 610D Emergency Disaster Plan was posted on front entry bulletin board. Emergency supplies (water, food, flashlights, batteries, first aid) were observed in the garage. Infection Control Plan was updated. Personnel Records & Training Four (4) staff files were reviewed and included criminal record clearances in all staff files. Current CPR/First Aid certificates were observed for S1-S3; however S4 certificate was expired, TB screenings documentation was present for S1-S3 however, no TB screening for S2 was observed. Required training was observed to be in files. Insurance Liability insurance was in compliance with an expiration date of April 4, 2026. An exit interview was conducted with Ana Aparicio, Caregiver. During the inspection, deficiencies were observed and cited on the attached LIC 809D/809C in accordance with Title 22, Division 6 regulations. A copy of this report, LIC 809D/809C, and Appeal Rights were provided.