Routine inspection·June 11, 2025

At 9:30am on 06/11//2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived unannounced to the facility to conduct the annual facility inspection. LPA met with Lead Staff Mylene Cavello (S1), LPA and S1 called administrator Maynard Marcos by phone who provided permission for S1 to sign for inspection visit. LPA noted that S1 has a LIC308, Designation of Facility Responsibility for this facility on file. S1 and LPA conducted a full tour of the facility. This facility is a single-story residential home with 5 resident bedrooms (one is dual occupancy), three and a half bathrooms (one is on-suite and two are for shared/public use). A staff bedroom is located off the dining room and the half bath located near the laundry room is for staff use. There is a living room, dining room, and kitchen. Access to the laundry room and garage is through a locked door for resident safety. LPA noted that the backyard has seating and shade for residents and visitors. LPA noted fresh fruit just outside the kitchen for residents to enjoy freely. Near the dining room there is a piano for residents, visitors, and staff to play. During visit LPA observed residents engaged in coloring and brain stimulating activities. LPA also observed multiple Home Health and Hospice staff visiting residents. The facility has battery operated smoke detectors in each room that are all working, the carbon monoxide detector is in the hallway and functioning normally. LPA observed a fire extinguisher near the kitchen that was in the green compression range, purchased on 03/10/2025. LPA tested facility hot water at 107.3*(f), within regulation temperatures 105*-120* (f). LPA observed at least 2 - days of perishable and at least 7 - days of nonperishable foods. LPA noted that the facility has no obstructions in hallways, doorways or exits. (Continued on LIC809-C) Medications are stored in a locked cabinet. Staff and client files are locked in a cabinet in the dining room. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records, finding no violations. LPA conducted a staff and resident file review. LPA and S1 conducted a review of the annual care tool modules. There were no deficiencies cited at this time. Exit interview, report signed, and report provided.