Routine inspection·November 20, 2025

Licensing Program Analyst (LPA) Jose De La Cruz conducted an unannounced required Annual Inspection. LPA Lopez later arrived and joined the visit. The facility file was reviewed prior to the visit. LPAs identified themselves, were granted entry by Director Agustin. LPA discussed the purpose of the visit with Director Jay Agustin. According to the facility’s license, there may be a maximum of 32 residents, all of whom may be non-ambulatory in at any given time at the facility site. The facility is approved for 7 hospice, 4 bedridden, and a waiver approved for non-physicians to prescribe medications. During today’s inspection, the facility’s current census is 26 residents living at the facility. There were 25 residents present at the facility site during the inspection and one on day program. LPAs inspected the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] The facility’s ambient internal temperature was comfortable and compliant, at 73 degrees(º) Fahrenheit (F). Hot water temperature at taps accessible to residents were also compliant: sink in restroom #1 delivered hot water at 105ºF; sink in restroom #2 delivered hot water at 105.3ºF; sink in restroom #3 delivered hot water at 105.1ºF. There was at least 2 days of perishable food, and at least 7 days of non-perishable food present. Cooking, dining equipment and utensils were present, and all safely stored. There were no toxic chemicals or poisons accessible to residents. Medications were properly labeled, as required, and stored in locked cart, which LPA inspected. The facility maintained medication logs, which LPA reviewed. No pools or bodies of water on the premises. Per administrator Agustin, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and the facility telephone were all working. Fire extinguishers were present (03) and serviced within the last 12 months. The first aid kit was complete and readily accessible. LPAs interviewed 2 staff and 5 residents, and reviewed staff and resident records. LPAs interviews did not raise any licensing concerns. The files that LPAs reviewed contained the required documents. Confidential records were stored in a locked area. Required licensing postings were observed in a visible area of the facility. There were no deficiencies observed or cited during today's annual inspection, but the facility received Technical Violation (TV) which may be found within this report. An exit interview was conducted with Administrator J Mhel Agustin, to whom a copy of this report, along with the Licensee/Appeal Rights (LIC9058 03/22), were provided at the conclusion of the visit. The signature below confirms that the documents were received.