Routine inspection·December 12, 2025

At 9:20am, on 12/12/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Licensee/Administrator Angelita Maravillas, announced who he was and the reason for the visit. Licensee and LPA conducted a full tour of the facility. This facility is a two story residential home. LPA noted only staff have access to the second floor where there are live-in staff bedrooms and bathrooms; all resident bedrooms and bathrooms are on the first floor. This facility has four resident bedrooms (two are dual occupancy), two shared half bathrooms, and separate shower room for resident use. There is a family room, living room with dining space, and a kitchen. A room for staff to take a rest break is located under the stairs. Access to the laundry room and garage is through locked doors for resident safety. LPA noted that the back patio has seating and shade for residents and visitors. The facility has battery operated smoke detectors in each room that are working, the carbon monoxide detector is in the family room above one of the doorways leading to the hallway with resident bedrooms and is functioning normally. LPA observed multiple fire extinguishers throughout the facility that are in the green compression range, purchased on 9/1/2025. LPA tested facility hot water at 108*(f), within regulation temperatures 105*-120* (f). LPA observed at least 2 - days of perishable and at least 7 - days of nonperishable foods. During today's visit LPA noted no obstructions in hallways, doorways or exits. During the tour at approximately 10:00am, LPA observed Staff #1 (S1) and Staff #2 (S2) providing care to Resident #1 (R1) with the bedroom door fully open not providing R1 with privacy and Resident #2 (R2) walked by R1's open door during the care to access the half bathroom at the end of the hallway. (Continued on LIC809-C) Medications are locked in a cabinet near the dining area. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records(CSMR), finding nine resident medications not documented on the CSMR and five expired medications. LPA conducted a staff and resident file review. LPA observed 4 of 4 resident reappraisals are not up to date or complete. LPA and Licensee conducted a review of the annual care tool modules. Exit interview conducted, deficiencies cited on LIC809-D pages, reports signed, and reports provided to Licensee.