Routine inspection·December 11, 2025

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Staff Luzviminda Obillo (S1) . During the visit, LPA observed 6 residents and 2 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with S1 which included the Living room, kitchen, dining room, 3 restrooms and 3 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. While touring bedroom #4, LPA observed the sliding glass door leading to the backyard, had a stick blocking its track, preventing the door from being opened. Staff S1 stated she placed the stick there because resident R1 has wandering behaviors. S1 stated at least once a week R1 will attempt to wander at night. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 70 degrees F, and hot water temperature was measured at 115 degrees F in resident bathrooms. Fire extinguisher was serviced in January 13, 2025. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by S1, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on December 5, 2025. Page 1 Out of 2. LPA reviewed 3 resident medications and centrally stored medication records. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed R1's Appraisal Needs & Services Plan dated March 19, 2025. During todays visit, Staff S1 informed LPA that R1 has wandering behaviors. LPA reviewed R1's file, which notes that R1 has a neurocognitive disorder. R1's Appraisal Needs & Services Plan dated March 19, 2025 does not address R1's wandering behaviors or provide any details regarding R1's plan of care. Furthermore, R1 and R3's Appraisal Needs and services plans do not provide background information about the resident such as but not limited to: brief description of residents medical history/emotional, behavior and physical problems, functional limitations, physical and mental capabilities. LPA requested to review resident R2's Appraisal Needs and Services Plan. Staff S1 could not find a copy of R2's Appraisal Needs and Services Plan. LPA reviewed staff training records. LPA noted the staff training records do not indicate the Number of training hours dedicated to each subject. Deficiencies cited during today's visit, see LIC809-D. This report was reviewed with Staff Luzviminda Obillo and a copy of the signed report was provided. Appeal rights were provided. Page 2 Out of 2. END OF REPORT .