Routine inspection·December 29, 2025

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at approximately 8:50 A.M. When the LPA arrived, there were two (2) staff members and five (5) residents present. The LPA was greeted by Caregiver, Ralph Renz Del Rosario and Jonie May Del Rosario. LPA informed the reason for the visit. Administrator was unavailable during today's visit, however caregivers are authorized to sign today’s report. Entrance Interview. Beginning at 9:15 A.M., the LPA, along with caregiver toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. The following was observed: KITCHEN : Kitchen appliances appeared to be in operable condition. At 9:22 A.M. hot water measured at 118.3 degrees. Cleaning supplies and knives were stored in a locked cabinet under the kitchen sink. The facility has a sufficient supply of perishable and non-perishable food. LPA conducted a review of expiration dates on some product labels. BEDROOMS: There are five (5) bedrooms in total, of which two (2) are private rooms, two (2) are designated for shared resident use and one (1) is a staff room. All bedrooms observed were furnished and contained beds, chairs, bedside tables and lamps. All beds have appropriate linens. Continued on LIC 809-C Continued form LIC 809 BATHROOMS: The facility has two (2) bathrooms, one (1) is a shared bathroom for residents, visitors and staff use and one (1) for private resident use. Resident restrooms were observed to be clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. Between 9:33 A.M. and 9:38 A.M. hot water temperature was measured and measured within the required range. LAUNDRY ROOM and GARAGE: LPA observed laundry room to be locked and inaccessible to residents in care. The garage is attached to the laundry room. Garage was observed to contain extra mobility aid supplies, decoration, cleaning supplies and storage. A low supply of Emergency water was observed in the garage. Technical Advisory (TA) issued. During today's visit staff purchased extra water supplies. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. A fireplace was observed to be inaccessible to residents in care. The facility maintained a temperature of 69 degrees. Facility provides sufficient space to accommodate both indoor and outdoor activities. LPA observed a working phone available for residents use whenever needed. Additionally, LPA observed three (3) hallway closets. One closet was unlocked and contained an ample supply of linen, towels, paper products and emergency food. The remaining two (2) closets were locked; one contained additional cleaning supplies, toiletries, and hygiene products, and the other housed medications for all residents, a complete first aid kit, and staff and resident files. Smoke and carbon monoxide detectors were tested at 9:45 A.M. and both were functional at the time of the visit. Fire extinguisher was observed to be fully charged and last serviced on 02/05/2025. OUTDOOR SPACE: The backyard has a covered outdoor area equipped with furniture for residents’ use. All exits and passageways were observed to be free of hazards. There were no bodies of water noted. Facility has one side gate. LPA observed side gate to be self-latching and closing with clear passageways for emergency exit use. Continued on LIC 809-C Continued form LIC 809-C INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control and the emergency disaster plan are adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually. Emergency disaster drills are conducted quarterly, with the last drill documented on 10/01/2025. During today's visit, LPA gathered the following items: Personnel Record (LIC500), Facility Roster (LIC9020A). Due to time constraints, LPA will return at a later date to conduct medication audit and review staff and resident records. No citations issued during today's visit, Exit interview conducted and copy of the report was issued.