Routine inspection·April 29, 2025

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced Required Annual Inspection. LPA was greeted, identified herself, and was allowed entry into the facility by Caregiver Teresita Duclayan to whom was explained the purpose of the visit. According to the facility’s license, the facility has a maximum capacity of six (6) residents, of whom one (1) can be bedridden, and five (5) can be non-ambulatory. The facility also has a hospice waiver for five (5) residents. LPA, accompanied by Caregiver, toured the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, 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 resident activities. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents in care. Medications were labeled, as required, and stored in locked areas. [Continued on LIC809C] [Continuation of LIC 809] No pools or bodies of water were observed on the premises. Per Caregiver, no firearms or ammunition are kept at the facility. Smoke alarms, emergency lighting, and facility telephone were all working. The facility does have a physical telephone. Fire extinguishers were newly purchased. First aid kit was complete and readily accessible. Due to time constraints LPA was unable to complete the annual inspection and will return at a later date. No deficiencies were cited during An exit interview was conducted with Caregiver Duclayan , and a copy of this report along with Licensee/Appeal Rights (LIC9058 FAS 01/16) was provided signature below confirms receipt of the reports.