Routine inspection·March 5, 2026

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced Required 1-Year visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Arlan Acosta. The facility has a licensed capacity of 6 residents, 2 of which may be non-ambulatory in bedroom #4 and has a hospice waiver for 6 residents. During today’s visit, the facility had a census of 6 non-ambulatory residents, 3 of which were receiving hospice services. As of 10/8/2024, the facility has a pending fire clearance request to increase the facility's capacity to 6 non-ambulatory residents. The Administrator for the facility is Laurice Gamab and their certificate was valid and current. During today’s visit, LPA inspected each room of the facility, including resident and staff rooms, private and common bathrooms, kitchen, garage, common areas, and outside space. No bodies of water, delayed egress, or secured perimeter were observed on the premises. The facility was found to be clean, safe, and in good repair with no pathway obstructions. LPA observed linens and hygiene products for resident use. The facility’s ambient and water temperature were measured within regulatory requirements at multiple locations. LPA observed locked storage for hazardous and/or toxic chemicals, which were stored separately from food supplies. LPA observed unlocked resident medications stored in the kitchen refrigerator. Staff Acosta stated that the medications stored in the refrigerator needed to be refrigerated and confirmed that the facility did not currently have a lockbox to secure the medications. Additionally, inspection of the medications cabinet revealed that daily doses of resident medications were stored in daily pillboxes. Continued on LIC809-C page... According to Arlan Acosta, no firearms or weapons are stored on the premises. LPA observed a minimum supply of 2-days of perishable food and 7-days of non-perishable food. The refrigerator and freezer temperatures were kept within requirements. Staff present at the facility had a criminal background clearance and association. LPA reviewed multiple resident and staff records. Staff records for Staff 1 were incomplete. [Caregiver Acosta was provided with an LIC811 Confidential Names List to identify S1]. The following deficiencies were cited for unlocked medication, medications not stored in their original container, and incomplete personnel records and noted on the attached LIC809-D pages. Additionally, an LIC9102TV Technical Violation regarding annual visits with medical professionals was provided. An exit interview was conducted with Caregiver Arlan Acosta, whose signature below confirms receipt of a copy of this report, the LIC811, and the Licensee Appeal Rights (LIC9058 3/22).