Routine inspection·August 11, 2025

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA Lopez identified herself, was granted entry by caregiver’s Francine Palomo and Jevi Soriano. LPA discussed the purpose of the visit with the caregiver’s Palomo and Soriano, and Licensee Paulo Ordinanza and lead caregiver Jonathan Luciano who both later arrived and joined the visit. According to the facility’s license, there may be a maximum of six (6) residents all of whom may be non-ambulatory of which one (1) may be bedridden in rooms 1 – 6 in at any given time at the facility site. The facility has an approved hospice waiver for 6. During today’s inspection, the facility’s current census is 5 residents living at the facility. There were 2 residents present at the facility site during the inspection. LPA, accompanied by Licensee Ordinanza, toured the interior and exterior of the facility, and inspected each room. The facility was clean 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. The bathroom needed sanitation as it smelled of urine and had urine around the bottom toilet. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities. The facility’s ambient internal temperature was comfortable and compliant, at 74.8 degrees Fahrenheit (F). Hot water temperature at taps accessible to clients were also compliant: kitchen sink measured hot water at 105.1 degrees F; sink in staff restroom #1 delivered hot water at 105.5 degrees F; and resident sink in restroom #2 delivered hot water at 107.6 degrees F. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] There was at least 2 days of perishable food, and at least 7 days non-perishable food present. The facility had extra food storage available. Cooking, dining equipment and utensils were present, and all safely cleaned and stored. There were no toxic chemicals or poisons accessible to residents. LPA observed there were several ants on top of a dining table in the back area which caregiver cleaned during the inspection. Licensee Ordinanza sprayed an ant killer on the outside area surrounding the facility during the inspection. Medications were properly labeled, as required, and stored in locked cabinet. The facility-maintained medication logs which LPA reviewed but was not properly filled-in for resident #1 (R1 – see confidential names list for additional information). Caregiver informed LPA the medication had been provided to the resident as directed by the prescription but had not been initialed in the MAR. LPA spoke with resident and confirmed their medication had been received the quantity of times as it directed on their prescription. No pools or bodies of water on the premises. Per licensee Ordinanza, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher was present (01) and serviced within the last 12 months. First aid kits (02) were complete and readily accessible. LPA spoke with staff and resident, and reviewed staff and resident records. During today’s visit there were 2 residents on the facility premise. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in a locked cabinet. Required licensing postings were observed in a visible area of the facility. Per Title 22, Division 6, Chapter 8, there were deficiencies observed and cited during today's annual inspection and may be reviewed on the LIC809-D page of this report. The deficiencies were cleared during the inspection. An exit interview, was conducted and a plan of correction was jointly developed with Licensee Ordinanza 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 the documents were received. The facility provided LPA with a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500, and Emergency Disaster Plan LIC 610-E, during their annual inspection.