Routine inspection (multi-day)·August 8, 2025

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced case management visit to continue the annual inspection started on 7/30/2025. LPA was greeted by, identified herself to, and explained the purpose of the visit with Administrator Teresita "Roxie" Roxas . The facility is licensed for a maximum capacity of 6 non-ambulatory residents, 1 of which may be bedridden in a room with a direct exit. The facility has a waiver for 4 hospice residents. During today’s visit, the facility had a census of 6 non-ambulatory residents. The Administrator for the facility is Teresita Roxas and their certificate was valid and current. During visits on 7/30/2025 and 8/8/2025, LPA toured the facility and inspected each room of the facility, including resident 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. LPA observed an enclosed area located in the facility garage that the Administrator stated were two staff rooms. The Administrator stated that the area was an Accessory Dwelling Unit (ADU) and did not require a building permit due to its size. LPA was able to observe one of the rooms to contain a bed. Administrator stated that staff would use the rooms as a break area or to sleep after long shifts. The facility’s water temperature was measured at 106.7 and 107.6 degrees Fahrenheit in bathrooms for resident use. The facility’s internal temperature was measured at 76 degrees Fahrenheit. LPA observed an unlocked cabinet located in the backyard that contained cleaning chemicals and staff stated the cabinet was usually locked. Staff locked the cabinet prior to the end of the inspection. Continued on LIC809-C page… According to "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 32 degrees Fahrenheit, and the facility freezer was kept at -7 degrees Fahrenheit. LPA observed linens and hygiene products provided to the residents that are in good repair and sufficient to meet their needs. Staff present at the facility during the time of the inspection had a criminal background clearance and had a first aid certificate. LPA reviewed multiple resident and staff records. Each resident record was complete and contained a signed admission agreement, initial medical assessment, updated annual reappraisal, documents regarding safeguarding personal property and personal rights. Each staff file was complete and contained a personnel record, first aid certificate, fingerprint clearance and association, and a health screening. The following deficiencies were cited for unlocked cleaning chemicals and fire clearance and noted on the attached LIC809-D pages. Additionally, a civil penalty in the amount of $500 was assessed for fire clearance violation and noted on the attached LIC421IM form. Additionally, an LIC9102TV Technical Violation regarding clearance transfers and an LIC9102TA Technical Advisory regarding exception requests were provided. An exit interview was conducted with Administrator Teresita "Roxie" Roxas, whose signature below confirms receipt of a copy of this report, the LIC9102TA and LIC9102TV, LIC421IM and the Licensee Appeal Rights (LIC9058 3/22).