Routine inspection·September 17, 2025

On September 17, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Administrator Teresita Lozano arrived shortly after and was available to assist with the facility inspection. The facility is licensed for six (6) non-ambulatory Residents with approved Hospice waiver for two. Currently, there is Five (5) Residents present during today’s visit. During today’s visit there was zero (0) residents on hospice. This is a single story with detached garage facility. The facility has six bedrooms (five resident rooms and one staff room), four restrooms, living room, dining room, kitchen and three bathrooms. At around 1:15PM, LPA conducted a tour of the physical plant accompanied by Caregiver, and the following was observed: Facility has pool in backyard with a secured gate. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for resident’s personal belongings was observed. Bed linens, blankets and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 107.9 to 114.6 degrees F. LPA observed the facility to be furnished at the time of the visit. Storage areas for cleaning supplies and sharps objects were stored and not accessible to residents. The kitchen was inspected, and facility has two day perishables and seven day non-perishable food. Facility has supply of emergency food and water. Facility has one fire extinguisher which was charged. CONTINUED ON 809C During the visit, LPA observed the facility has supply of Personal Protective Equipment (PPE). LPA observed First Aid Kit was maintained. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. The facility has current liability insurance on file effective 6/27/2025 – 6/27/2026 A review of five Residents (R1-R5) service files and three staff (S1-S3) personnel files was conducted. LPA verified Administration certification on file for Teresita Lozano - Expiration 5/22/2027. A technical Violation was issued during visit. An exit interview was conducted with Administrator Teresita Lozano and a copy of the report was provided.