Routine inspection·January 8, 2026

On 01/08/2026 at approximately 09:30AM, Licensing Program Analyst (LPA) Ali Deniz arrived unannounced to conduct 1-Year Required visit of this licensed Residential Care Facility for The Elderly (RCFE). LPA was greeted by Administrator, Mary Jane Miranda. Facility has an approved fire clearance and capacity for 6 non-ambulatory residents and has an approved hospice waiver for 3 individuals. Upon arrival, LPA was informed that there was only 1 (one) resident in care and 1 (one) staff member on-site. Facility is a 1 story building with 4 Resident bedrooms, 1 staff bedroom, 2 bathrooms, and common spaces. At approximately 10:05 AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 11:05AM, LPA and Administrator toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored in a locked housekeeping closet in the laundry room and under the kitchen sink. Water temperature measured 106.6 degrees F and 107.4 degrees F which is within regulation between 105- and 120-degrees F at faucets accessible to residents. Fire Extinguishers found to be last charged on 02/24/2025 at the time of visit. Carbon Monoxide and smoke detectors were present and in order. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure in a cabinet in the living room. Continued on LIC809-C page... Continued from LIC809 page... At approximately 2:05PM, LPA reviewed 1 resident record and found signed admission agreements, and physician's report on file. Administrator agreed to obtain resident’s missing files; Needs and Service Plan and TB test results (Technical Violation given). Medication records are thorough and contained physician's orders for each resident. At approximately 11:45AMM, LPA reviewed 2 staff records. All records did contain required documentation. LPA was presented with proof of current CPR & 1 st Aid certification for the whole staff. Administrator Certificate is for Mary Jane Miranda #7017663740 expires 01/28/2027. LPA reviewed the facility emergency disaster plan. Facility has supplies enough to operate for more than 72 hours in an emergency. Administrator couldn’t find documentation of conducted disaster drills (Technical Advice Given). Updated copies of the following documents were requested for facility file and are to be submitted to CCL by due date of 01/20/2026: LIC 308 Designation Facility Responsibilities LIC 500 Personnel Summary LIC 9020 Register of Facility Client’s/Resident’s Copy/Proof of Updated Certificate of Liability Insurance No deficiencies were observed in the areas inspected, No citations were issued during today’s visit. Exit interview conducted. Copy of report provided to Licensee. Signature on form confirms receipt of documents.