Routine inspection·September 18, 2025

On September 18, 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 Lisa Dela Rosa was not available to assist with the facility inspection. Staff contacted Administrator to notify of visit. Caregiver Linda Herlina is signing on behalf of Administrator. The facility is licensed for six (6) non-ambulatory residents with approved hospice waiver for six (6) residents. Currently, there are five (5) Hospice residents present during today’s visit. This is a single story with a detached garage facility. The facility has five bedrooms (4 private rooms,1 shared) and two full bathrooms. LPA conducted a tour of the physical plant accompanied by Caregiver Linda Herlina, 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 between 107.7 to 109.7 degrees F. A comfortable temperature of 79 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene 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 two fire extinguishers that were mounted and fully charged. A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents. LPA observed the facility has supply of Personal Protective Equipment (PPE). PUB 275 see something say something poster was posted. LPA observed First Aid Kit was maintained. A working landline phone was operational. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. The facility has current liability insurance on file effective 12/5/2024 – 12/5/2025. A review of Six residents (R1-R6) files revealed to be complete. The facility has the current administrator's certification on file for Lisa Dela Rosa # 7010009740 - Expiration 05/05/2026. No deficiencies during this inspection visit. An exit interview was conducted with caregiver, and a copy of the report was provided.