Routine inspection (multi-day)·November 6, 2025

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility at 1:20 p.m. to conduct an unannounced continuation of the annual inspection that began on November 5, 2025 (11/05/2025). Upon arrival LPA was greeted by Assistant Administrator / Designee and explained the reason for the visit. The LPA met with Assistant Administrator, Magdalena Garcia and Administrator Designee, Marisol Flamenco and reason for the visit was explained.Entrance interview. During the annual inspection that was conducted on 11/5/2025 LPA Mosley conducted the full physical plant tour in which LPA observed the common areas, bedrooms, restrooms, kitchen, backyard, garage and conducted staff and resident interviews and obtained pertinent documentation. During today’s visit, starting at 1:22 p.m. LPA conducted the entrance interview and a brief physical plant tour to ensure there are no immediate health and safety concerns, and facility is in compliance with Title 22 Regulations. The following was noted: The facility is a single-story residential home with an attached garage. Six (6) private resident rooms, and two (2) restrooms. There is no staff room and Administrator stated that staff remain awake at night. The facility is fire cleared for six (6) non-ambulatory residents of which one (1) may be bedridden and a hospice waiver for five (5). During the visit LPA observed a music class where residents were actively participating. Activities observed. Report Continued on LIC 809-C PAGE 2 ... (PAGE 2) Report Continued from LIC 809-C... RECORDS: Resident Records : were reviewed beginning at 1:43 p.m. six (6) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. Personnel Records were reviewed beginning at 2:59 p.m. five (5) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete and updated annually as required. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard. MEDICATIONS: Medication review began at approximately 3:26 p.m. Medications are centrally stored and locked in a medication cart located in the kitchen adjacent garage entrance. Medications for three (3) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed during review. LPA observed the first aid supplies to be complete, including a thermometer and a current version of a first aid manual. DOCUMENTS: LPA obtained the following documents during initial visit on 11/5/2025 LIC 500 facility roster , LIC 9020A Resident roster and copy of the Limited Liability insurance. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report reviewed and provided.