Routine inspection·August 25, 2025

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Esperanza Sotto and Licensee Teresita "Roxie" Roxas. The facility is licensed for a maximum capacity of 6 non-ambulatory residents and has a waiver for 4 hospice residents. During today’s visit, the facility had a census of 4 residents, 3 of which were non-ambulatory. The Administrator for the facility is Teresita "Roxie" Roxas and their certificate was valid and current. During today’s visit, LPA toured the facility and inspected each room of the facility, including resident and staff rooms, bathrooms for resident and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed on the premises. LPA did not observe any aspects of delayed egress or secured perimeter. The facility was found to be clean, safe, and in good repair. The facility’s water temperature was measured at 105.4 degrees Fahrenheit in a bathroom for resident use. The facility’s internal temperature was measured at 77 degrees Fahrenheit and LPA observed multiple fans to maintain air flow. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. According to Teresita "Roxie" Roxas, no firearms or weapons are stored on the premises. LPA also observed locked storage for resident medications and resident and staff files. Resident medications are stored in their original container and labelled. LPA observed a minimum of a 2-day supply of perishable food and a 7-day supply of non-perishable food present at the facility. The facility refrigerator was kept at 38 degrees Fahrenheit, and the facility freezer was kept at 0 degrees Fahrenheit. LPA observed linens and hygiene products provided to the residents that are in good repair and sufficient to meet their needs. Continued on LIC809-C page… Staff present at the facility during the time of the inspection had a criminal background clearance and were associated to the facility. LPA reviewed multiple resident and staff records. Each resident record contained a signed admission agreement, initial medical assessment, and updated annual reappraisal. However, 4 of 4 resident records did not contain a signed copy of personal rights. Each staff file was complete and contained a personnel record, first aid certificate, fingerprint clearance and association, and a health screening. LPA provided Licensee with consultation and guidance regarding the regulation changes that became effective 1/1/2025. The following deficiency was cited for personal right documentation and noted on the attached LIC809-D page. Additionally, an LIC9102TA Technical Advisory regarding egress routes was provided. An exit interview was conducted with Licensee Teresita "Roxie" Roxas, whose signature below confirms receipt of a copy of this report, the LIC9102TA and the Licensee Appeal Rights (LIC9058 3/22).