Routine inspection (multi-day)·September 23, 2025

At approximately 2:00 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a Case Management - Annual Continuation inspection and was greeted by staff. LPA met with Xiomara Robles, Licensee and Anya Balaoy Licensee/Administrator. Facility is a Residential Care Facility for the Elderly (RCFE) with one (1) resident in care. Facility has a Dementia Care Plan and is approved for all non-ambulatory residents. At approximately 2:10, LPA conducted file review of three (3) staff files and one (1) client file and observed the following: Three (3) of three (3) staff files reviewed have the required paperwork and proof of inital and annual training hours per regulation. Two (2) of three (3) staff have proof of the required current first aid training certification. Licensee understands that first aid is a minimum requirement for all care staff and agrees to have Staff 2 (S2) complete their first aid training prior tho their next shift. The one (1) client file reviewed was missing the emergency ID form, personal rights form, and the consent for emergency medical treatment. LPA explained the required documentation to Licensee who conveyed an understanding and agreed to bring the facility into compliance with regulation. At approximately 3:10, LPA conducted a review of medications and medication records which were observed stored and maintained in accordance with regulation. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit : LIC610E - Emergency Disaster Plan Exit interview conducted with Licensee whose signature on form confirms receipt of documents.