Routine inspection·October 29, 2025

On October 29, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA Tirre was greeted by staff and granted entry after stating the purpose of the visit. Staff contacted Administrator Patricia O’Connel to notify of Licensing visit. Caregivers Mack Delos Reyes and Lilian Manlulo were able to assist with inspection visit. The facility is licensed for six (6) non-ambulatory residents with approved hospice waiver for four (4) residents. Currently facility has capacity of six (6) residents of which four (4) Hospice residents present during today’s visit. This is a single story with attached car garage facility. The facility has five bedrooms (two shared resident rooms and two private rooms) one staff room, and three bathrooms (two for residents and one for staff). LPA conducted a tour of the physical plant accompanied by staff, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 110.6 degrees F. LPA observed the facility to be furnished at the time of the visit. Storage areas for toxins, cleaning supplies and sharps objects were stored and not accessible to residents. CONTINUED ON 809C The kitchen was inspected, and sufficient two day perishable and seven day non-perishable food was maintained adequately. Facility has one fire extinguisher which was mounted and fully charged. A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance. Facility has supply of emergency food and water. During the visit, LPA observed the facility's infection control practices. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. The last fire drill was conducted on October 3, 2025. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. The facility has current liability insurance on file effective 12/25/2024 – 12/25/2025. A review of six residents (R1-R6) service files and three staff (S1-S3) personnel files revealed to be complete. The facility has the current administrator's certification on file for Patricia O’connell # - 7006170740 expiration 9/25/26. No deficiencies during this inspection visit. An exit interview was conducted with Caregiver Mack Delos Reyes, and a copy of the report was provided.