Pre-licensing visit·September 9, 2025

On 09/09/2025, Licensing program Analyst (LPA) Jaime Vado conducted an unannounced prelicensing inspection. LPA met with a designated administrator Lovely Hurtado and explained the purpose of today’s visit. Currently there are 6 residents and 3 staff present. One of which is the administrator. This is a single level facility with 6 bedrooms for residents. The facility is licensed for age 60 and over. All may be non-ambulatory. With a hospice waiver for 2 residents. At this time there are no residents under hospice care. LPA Vado toured the facility both inside and outside. All outdoor and indoor passageway are free and clear of obstructions for emergency exit routes in case of fire or emergency. Facility's ambient temperature is comfortable for residents and LPA. No pools or bodies of water were observed during today's visit on the premises. LPA observed fresh food supplies and emergency one week of nonperishable and two (2) days of perishable foods as in place. Dry goods/can goods are stored in a pantry adjacent to the kitchen. Knives are locked in a drawer next to the refrigerator. Toxic chemicals/cleaning supplies are observed to be locked in the garage of the facility. The garage also contains the laundry area, and both the washer and dryer are observed as functional. There is an additional refrigerator in the garage for resident and staff items. Medications are observed as locked in a credenza in the dining room. Each resident room observed contained the required furniture as outlined in regulations. Facility has functioning smoke detectors within the facility as well as carbon monoxide detectors located through out the facility. Fire extinguishers are observed with inspection dates of 09/13/2024. There are two fire pull stations in the facility, both are located at each door of the facility. The facility is equipped with one common bathroom in the main hall, which is where residents also bathe. Non-skid mats and grab bars are in place. Water temperature is tested at 105F. Continued on next page... Page 2 LPA observed all resident rooms as clean, free of odors, and contained all the required furniture per regulatory recommendations. Resident bathrooms are observed as clean and in good worker order. LPA observed resident linen supplies stored in a hallway closet. Shower floors are equipped with non-skid mats or flooring. LPA inspected the medications and files of 5 residents in care at the facility. Based on review of all resident files, and medications all items are current and logged accurately. 5 staff files are reviewed and they are observed as current. Disaster/fire drill log is reviewed. The last drill is observed to have taken place on 09/03/2025. Facility administrator certificate for Lovely Hurtado is observed as current expiring 06/07/2026. Component III is conducted on this day. There are no citations issued on this day. Report is reviewed with administrator Lovely and a copy is provided.