Non-compliance follow-up·April 29, 2026

On 4/29/2026 Licensing Program Analyst (LPA) Shakaricka Hughes conducted an unannounced visit to the facility. The purpose of the visit was to conduct a Case Management- Quarterly visit the facility to ensure that facility remains in compliance as outlined in a NCC meeting held on 11/18/2025. LPA met with the facility administrator Sera Nakalevu, who assisted LPA during today’s visit. The current census is 14 with 3 staff present. The following items were required to be maintained in compliance while this facility is under increased monitoring with quarterly visits: Staff background checks - LPA reviewed the Guardian roster of all staff listed on the LIC 500, all staff listed were background cleared and associated with the facility. LPA advised the administrator to disassociate employees no longer working inside of the facility and accurately update work hours for employees listed on the LIC 500 report. Signal system - LPA observed a signal system in place for the facility, including attached dwelling units for resident bedrooms. The facility is in the process of changing the signal system to one single signal system for all residents’ rooms, currently the facility utilizes two separate signal systems both signal systems were observed functional and in good repair at this time. Incontinent care- LPA toured the inside of the facility including resident bedrooms and observed the facility to be clean and free of odor. Continuation 809-C Incidental Medical and Dental- LPA checked resident medications including the Medication Administration Record (MAR) and Centrally Stored Medication and Destruction Record (CSMDR) for 5 out of 14 residents in care, and it was observed complete. Food supplies- LPA observed 2-day and 7-day perishable and non-perishable food supplies for residents and both were observed sufficient to meet the needs of residents at this time. There were no deficiencies observed or cited during today's case management visit. An exit interview was conducted and a copy of this report was provided to the facility.