Routine inspection·September 11, 2025

At approximately 8:30 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit and was greeted by Caregiver (CG) John Manuit. Administrator Arthur Alcones arrived at 9:00 AM. Sleepy Hollow Assisted Living is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for six (6) non-ambulatory residents, one (1) of whom can be bedridden. The facility has a Hospice Waiver for two (2) residents. Upon arrival, LPA was informed that there were four (4) residents in care and two (2) staff members on-site. At approximately 9:05 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 9:15 AM, LPA toured the facility with Administrator Alcones. All exits were clear and unobstructed. The facility's one (1) fire extinguisher was last serviced and tagged in December, 2024. The facility was sufficiently lighted. LPA inspected five (5) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills monthly. The last disaster drill was conducted on 7/15/2025. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. Continued on 809-C... ...Continued from 809 At approximately 10:00 AM, LPA reviewed four (4) resident files. Four (4) of four (4) resident files were observed to be well organized and thorough with all required documentation. LPA reviewed four (4) staff files. All staff files were observed with all required documentation including First Aid and CPR certification and proper training documentation. LPA spot checked Medication for two (2) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. Arthur Alcones’s Administrator Certification 7009494740 is current with an expiration date of 8/23/2026 . LPA requested the following documents be submitted to Community Care Licensing by 10/11/2025: LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Proof of Liability Insurance The facility is in compliance. No deficiencies cited during today's visit. Exit interview conducted. Copy of report discussed and provided to Administrator Alcones. Signature on form confirms receipt of documents.