Non-compliance follow-up·November 4, 2025

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting a case management visit following up on the non-compliance conference that took place on July 30, 2025. LPA was greeted and granted entry after introducing himself and stating the purpose of the visit. Administrator Janine Cuyson was notified via telephone and arrived later to assist with the visit. During the present visit, LPA accompanied by staff conducted a tour of the physical plant and observed the following: There are currently 5 residents in care along with two staff members present. Utilities are confirmed to be running, electricity and air conditioning are in operation. Bathroom faucets are verified to dispense hot water at 108F. Food supplies are verified to be present in sufficient quantities. Emergency food and water supplies are present. Cleaning and laundry supplies are present as well. LPA conducted two staff interviews and attempted multiple resident interviews. Additionally, LPA requested the following documentation from facility staff: - Payroll records for August, September, and October, 2025, (provided during the visit) - Grocery receipts for August, September, and October, 2025 (provided during the visit) - Utility bills (water, gas and electricity) or August, September, and October, 2025 (provided during the visit), - Proof of rent payments for August, September, and October, 2025 (provided). CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 Per a review of the utility bills provided, no payments were made towards the amount due for electricity service to the facility in either September or October, resulting in a past due balance of $3,154.59. Additionally, no payment was made towards the natural gas bill issued in October 2025 as a November 1. The account is also flagged as being "Cash Only" which indicates a history of missed or returned payments. One work wage payment to a staff member also shows as having been returned before being successfully paid out in the following days. Type B deficiency cited. Based on the observation and records reviewed during the present visit, one type B deficiency is being cited during the present visit. An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.