Routine inspection·September 17, 2025

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation using the CARE Inspection Tool. LPA was greeted and granted entry by Caregiver Jordan Frias after stating the reason for the visit. Administrator (Admin) Sherry Dizon arrived on premise shortly after. The administrator's certificate for Admin Sherry Joyce Dizon expires on November 26, 2025. LPA also verified completion of course work for Administrator Emmanuel Dizon. The following was observed during the inspection: This is a single story property located in a residential neighborhood. Facility operates within the conditions and limitations specified on the license. LPA observed six residents in care with three residents receiving hospice service. LPA observed two caregivers on duty and verified fingerprint clearance and association statuses. All common areas were inspected including the attached two car garage. LPA observed six resident bedrooms, six resident bathrooms, and one private staff bedroom occupied by four staff. LPA observed the residents' bedrooms were appropriately furnished, beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage space for each residents' personal belongings were observed. No bathrooms were found to be in compliance, clean. and/or in good repair as all bathrooms require a deep cleaning mainly in the shared bathroom between the bedrooms of Resident #5 (R5) and Resident #6 (R6) evidenced by a hole and water stain on the ceiling above the shower as well as mold and pink stains in the grout. The hot water temperature measured at 108.1, 107.4, 107.2, 106.8, 109.4, and 110.8 degrees Fahrenheit in the resident bathrooms. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food. LPA toured the exterior portion of the facility. LPA observed the outdoor passageway is free of obstruction. The exit gates were operational and there were sufficient seating and shading. The fire extinguishers were mounted, charged, and serviced on April 15, 2025. The auditory devices and dual functioning smoke/carbon monoxide detectors were tested and operational. LPA observed the emergency food/water and supplies centrally stored in the garage. Emergency drills were not conducted quarterly. The drill was conducted once this year on August 6, 2026. LPA observed the required 'See Something, Say Something' (PUB475) poster posted in the correct size in the entry way. LPA interviewed residents. No staff were interviewed due to insufficient time. LPA reviewed six residents' files, and two personnel files in which no discrepancies were found. Medications were audited for two out of six residents. No discrepancies found with the administration of medications, however the documentation of the medications were not completed timely. LPA consulted the following: to ensure that the facility is clean, sanitary, and in good repair at all times, to ensure medications administered are documented timely, to review the emergency disaster plan annually, and to conduct emergency drills accounting various scenarios on a quarterly basis. Based on the observations made during today's visit, deficiencies are being cited, and Advisory Notes (LIC9102s) are being issued. An exit interview was conducted with Administrator Sherry Dizon, and a copy of this report including the Confidential Name (LIC811) and the appeal rights were provided at exit.