Routine inspection·September 17, 2025

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at 10:00 A.M. LPA met with Administrator, Charmie Hayag and Licensee Maricel Villaverde. Entrance interview conducted. Beginning at 10:15 A.M., the LPA, along with Administrator and Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. Facility has a fire clearance for six (6) bedridden residents. The following was observed: COMMON AREAS : This includes the living room, dining room areas and recreation/sitting area. LPA observed common areas to be clean and properly furnished at the time of the visit. The LPA observed activities for resident use in the recreation/sitting area as well as an office area. Office area had a computer desk, a phone available to everyone and residents and staff files. The fireplace was observed adequately screened. The LPA observed the fire extinguisher to be fully charged and last serviced on 04/11/2025. Hardwired smoke detectors and a separate carbon monoxide detector were tested at 10:45 A.M. and were functional at the time of the visit. Additionally, this facility is equipped with a sprinkler system. The last inspection by RLD Fire Protection. Inc wa conducted on 06/12/2025. No concerns noted. The LPA observed the required postings throughout the facility. The facility is equipped with a fire door to enhance safety and prevent the spread of fire. During today’s visit, the fire door was observed closed. Continued on LIC 809-C Continued from LIC 809-C OUTDOOR SPACE: The backyard has a covered patio area with patio furniture including a table and chairs for residents’ use. Facility has two total gates; both were observed to be self-latching and closing with clear passageways for emergency exit use. LPA did not observe any obstructions or hazards on hallways nor exits during the visit. There were no bodies of water on the premises at the time of the visit . A separate locked ADU unit was observed on the property and is used to house an adult family member, who has fingerprint clearance and is associated to the facility. RECORD REVIEW: Began at 12:20 P.M. (resident records) and 12:50 P.M. (staff records.) Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. All three (3) resident records reviewed were complete and contained all required documents. All five (5) staff files reviewed were also complete and contained all required documents. LPA requested the following documents: staff schedule, resident roster, liability insurance and last emergency drill. The last emergency drill was conducted on 09/01/2025. MEDICATION REVIEW: Began at 1:15 P.M. Medications for three (3) of three (3) residents were observed. Medications are stored in a locked hallway closet. All medications observed were labeled, stored, and properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. LPA observed two (2), 1 st Aid kit and respective manuals inside locked medication closet. No deficiencies cited. Exit interview conducted. A copy of the report was provided via email. Continued from LIC 809-C BEDROOMS: There are four (4) bedrooms in the facility. At the time of the visit, LPA observed one shared room and two (2) single occupancy bedrooms. Also, LPA observed a locked staff room. All residents’ rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. BATHROOMS: There are two (2) bathrooms for residents’ use. Bathrooms were observed to be equipped with slip-resistant surfaces and contain slip-resistant mats. Grab bars were observed in the bathrooms. The LPA observed sufficient amounts of soap and paper products in each restroom, as well as hand washing posters. Toilets were observed to be operable. The hot water temperature in all bathrooms was tested and initially measured below 105 degrees Fahrenheit. The water heater temperature was adjusted at that time. LPA subsequently retested the hot water in all bathrooms, and the temperatures were found to be within the regulatory range. KITCHEN: The LPA observed the kitchen. Kitchen appliances were in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food. Also, emergency water and food are adequate. The LPA observed one designated cabinet where knives and sharps are stored locked and inaccessible to residents. Cleaning supplies are located in a locked cabinet under the kitchen sink. At 10:22 A.M. hot water temperature measured 109.7 degrees Fahrenheit. LAUNDRY & GARAGE/STORAGE: The locked laundry room is located adjacent to the kitchen. Laundry supplies and chemicals are stored inaccessible to residents in care. Laundry area also contains an extra freezer, pantry, and emergency food/water supply. Garage was converted into a storage room. Storage room was locked at the time of the visit and contained a small break room for employees, extra PPE supplies, cleaning supplies, backup generator, and extra food supply. Continued on LIC 809-C