Non-compliance follow-up·May 21, 2026

At approximately 04:30 PM, Licensing Program Analyst (LPA) Julie Florio arrived at this facility unannounced to conduct a Health, Safety, and Wellfare follow-up and Case Management Legal/Non-Compliance visit and was greeted by Teresita Buenavista, Caregiver. Jean Felix, Licensee was not present in the facility and was contacted via telephone by caregiver. Licensee expressed that she is not feeling well and was unable to come to the facility for today's visit. The facility currently has two residents, one of whom is in the hospital. Licensee is closing the facility due to inability to meet current fire code requirements to continue operating at this location as an Adult Residential Care Facility for the Elderly (RCFE) with non-ambulatory residents in care. Facility was initially 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. LPA was able to confirm with Licensee via telephone that they still plan to issue a 60-day notice to the two remaining residents formally informing them of the facility's closure. Licensee agreed to submit a copy of a regulatory compliant closure notice to the Department by COB tomorrow, Friday, 05/22/2026. Licensee stated they are assisting the current residents with new facility placement. Continued on LIC809C... Continued from LIC809... One is away in the hospital delaying the process. Both residents and their responsible parties have been verbally notified of the facility's closure. Today, LPA followed up on requested financial monitoring documents due by 05/26/2026 for 1st Quarter 2026: January, February, and March 2026 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) supporting the amounts entered on the LIC401 3. Balance sheet for March 2026, 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. 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 Caregiver whose signature on form confirms receipt of documents.