Non-compliance follow-up·December 2, 2025

At approximately 11:10 AM, Licensing Program Analyst (LPA) Julie Florio arrived at this facility unannounced to conduct a Case Management Legal/Non-Compliance visit and was greeted by Jean Felix, Licensee. Facility was placed into Non-Compliance for the following reasons: Lack of Liability Insurance in the proper amounts Lack of proper funds to properly maintain facility LPA toured the facility to ensure residents were safe and secure and that there was proper amounts of food stores, power, water and heat. Facility was a comfortable temperature and had power, water, and heat. Food stores were sufficient to sustain residents in care for seven (7) days as required per regulation. On 11/21/2025, LPA received an email from prospective licensee stating they decided not to proceed with a change of ownership application and would cease operation of the facility effective immediately. During an in-office meeting with current licensee and prospective licensee on 11/19/2025, current licensee agreed that if prospective licensee backed out, then current licensee would submit all requested financial monitoring documentation in the name of the current license/licensee by COB, Friday, 12/05/2025 to avoid legal action against the facility. Today, LPA followed up on requested financial monitoring documents due by 12/05/2025 for 2nd Quarter 2025: April, May, June 2025 monitoring period to include: 1. Profit & Loss statements for the months identified above or in the report 2. Rent, payroll, income & expense third party documents such as utility statements (gas, electric, etc) Continued on LIC809C... Continued from LIC809... supporting the amounts entered on the LIC401 3. Balance sheet for June 2025, and supporting third party documents, such as liabilities (loans, credit cards) supporting the amounts entered on LIC403 4. All Bank statements used for the operation of the facility for the months identified, cash reserve documents for the facility's emergency needs 5. Current General Liability Insurance and Workers Compensation Insurance.6. Any financial records deemed relevant to support the licensee has an adequate financial plan, as required by law, such as Form 941, the Employer's Quarterly Federal Tax Return, & Quarterly Contribution Return and Report of Wage - DE 9. Additionally, during today's visit, Licensee provided LPA with proof of current General Liability Insurance, Workers Compensation Insurance, and a current administrator certificate for the new facility administrator, Phoebe Lomo, certificate #7030087740, effective 01/30/2025, expiration 01/29/2027. Licensee agrees to submit the following documents required for the change of administrator to the Department by COB 12/05/2025: LIC 200 LIC 308 Designation of Facility responsibility (designation of who is the administrator) Administrator Certificate First Aid Certificate Administrator Resume LIC 500 Personnel Report LIC 501 Personnel Record LIC 503 Health Screening Report - personnel TB test that shows "negative" LIC 9182 Criminal Record Exemption Transfer Request LIC 610 Emergency Disaster Plan for Residential Care Facilities for the Elderly Copy of Personal ID continued on LIC812C... Continued from LIC812C... Copy of Board of Directors' Resolution meeting minutes signed (required for all corporations) LPA will return to regional office to conduct further file review and consult with licensing program manager (LPM). No citations issued during today's visit. Exit interview conducted with Licensee whose signature on form confirms receipt of documents.