Roxies Elderly Homes II

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced Case Management visit to the facility. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Caregivers Marilyn Tanarte and Ofelia Fortunato. Today's visit was in response to the facility's pending closure, and to confirm relocation progress for the residents in care. During today's visit, LPA conducted a wellness check at the facility and no health or safety issues were identified. LPA also spoke with caregiver Emma Hamto over the phone earlier this morning to obtain updates about the pending resident move-outs. No deficiencies were cited during the inspection. An exit interview was conducted with Caregiver Tanarte to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jul 22, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced Case Management visit to the facility. LPA identified themselves and discussed the purpose of the visit to Caregiver Anita Sulangi. Today's visit was in response to the facility's pending closure, and to confirm relocation progress for the residents in care. Four (4) residents were at the facility during the visit; one (1) resident was in the hospital and one (1) resident was at day program. LPA conducted a wellness check at the facility; no health or safety issues were identified. No deficiencies were observed or cited during the facility visit. An exit interview was conducted with Caregiver Ofelia Fortunato, to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jul 15, 2026

Type of visit: Office

A scheduled virtual office meeting was conducted on 06/30/2026 with Licensing Program Managers (LPMs) Lizzette Tellez and Simon Jacob, Licensing Program Analysts (LPAs) Nacole Patterson, Arian Golbakhshs, and Eryn Kane, and family members of Licensee Ashley Schmitt and Andrew Roxas-Asevo. The purpose of the meeting was to discuss the plan for the facility due to the passing of Licensee Teresita Roxas. During the meeting Ashley Schmitt and Andrew Roxas-Asevo informed of their intent to close the facility. Closure procedures and a transition plan were discussed, including required notifications, facility visits, and placement plans for all residents currently living at the facility. No deficiencies were cited during today's office meeting. An exit interview was conducted with Ashley Schmitt and Andrew Roxas-Asevo, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided via Adobe Sign.the state’s words, verbatim · CDSS document, Jun 30, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an announced Case Management visit to the facility. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Caregiver Emma Hamto. Today's visit was in response to the unexpected passing of Licensee/Administrator Teresita Roxas, who passed away 06/26/26. During today's visit, LPA conducted a wellness check at the facility and briefly chatted with residents. When LPA was reviewing staff records, LPA noted that two (2) staff members present at the home (identified as S1 and S2) were not included on the facility's association roster. Review of the files for S1 and S2 revealed that both did not have complete documentation of background clearances or associations in their files. Review of the Guardian background check database revealed both S1 and S2 did have eligible background clearances, but that they were not associated to the facility. Per interviews with S1 and S2, S1 had been working at the facility for 3 years and S2 for about 2 years. One type A Deficiency is being cited per California Code of Regulations, Title 22, Division 6 on the attached LIC 809-D for the two (2) staff working without having their clearances associated to the facility. In addition, Civil Penalties are being assessed for the total amount of $1,000.00. Details are noted on the attached LIC 421BG form. One deficiency was cited during the inspection. An exit interview was conducted with caregiver Griffith to whom a copy of this report, the LIC 421BG, and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jun 29, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: Jul 13, 2026

87355(e)(2) "All individuals subject to a criminal record review [...] shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c)" This requirment is not met as evidenced by: Based on LPA file review and interview, the licensee did not comply with the section cited above in ensuring that 2 staff members had their clearances transfered prior to working at the facility, which poses an immediate health, safety, and personal rights risk to 6 out of 6 persons in care.the state’s words, verbatim · CDSS document, Jun 29, 2026

Plan of correction: Licensee was able to associate the two (2) staff members during the visit, eliminating immediate risk. Licensee will review the facility association roster to ensure it is up-to-date. Additionally, Licensee will conduct review of regulation 87355 and submit proof to LPA by POC due date.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced Case Management Visit. LPA was greeted by and met with caregiver Claire Griffith to discuss the purpose of the visit. Designated Administrator Ashley Schimitt was available by phone. Today's visit is in response to the unexpected passing of Licensee Teresita Roxas, who passed away this morning 06/26/26. LPA conducted a wellness check at the facility; no health or safety issues were identified. No deficiencies were cited or observed on this date. An exit interview was conducted with caregiver Claire Griffith, who was provided with a copy of this report and Appeal Rights (LIC9056 03/22). Their signature confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jun 26, 2026

Allegation investigated: Licensee did not provide activities Licensee did not provide hygiene items Licensee did not provide reasonable accommodations

Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to close out a complaint on the above-mentioned allegation. LPA gained access to the facility, identified herself, and met with Teresita Roxas, Administrator to discuss the purpose of the visit. LPA Borruda conducted a tour of the facility, and conducted interviews on 08/02/2023. LPA Holmes conducted interviews with residents, staff and outside sources. It was alleged that the licensee did not provide activities, the licensee did not provide hygiene items and that the licensee did not provide reasonable accommodations. Interviews revealed that the residents just sit around the facility and watch television or read the news paper. Prior LPA observations revealed there were no activities out for the residents use and interviews with the residents revealed there is nothing for them to do but sit around and or watch television. Interviews and observations also revealed that the residents did not have paper towels in the bathrooms and that they would wash their hands and dry them with toilet paper. Interviews also revealed that the facility did not provide reasonable accomodations by running the air condioner instead of fans. LPA observations revealed several fans around the facility and in the resident rooms. The thermostat read 81 prior to noon on the day they were there and then 84 degrees by 1pm. LPA Holmes observation on todays visit is that the facility was cool and the doors were open to let the air in. Based on the evidence obtained from interviews, the complaint allegations are substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. A deficiency is cited per Title 22 California Code of Regulation on the 9099 D page. An exit interview was conducted with Teresita Roxas, Administrator and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit. Substantiatedthe state’s words, verbatim · CDSS document, Jun 4, 2026 · control 08-AS-20230725091856

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87219(a)(2)(3) · Plan of correction due date: Jun 10, 2026

Planned Activities (a) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities. The activities made available shall include:(2) Daily living skills/activities which foster and maintain independent functioning. (3) Cognitive and mental stimulation activities such as reading, writing, movies, crossword puzzles, board and card games, and using the computer. This requirement was not met as evidence by: Based on observations and interviews, the licensee failed to provide activities for 6 out of 6 residents (R1-R6) This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 4, 2026

Plan of correction: Licensee will purchase games and puzzles for the residents use. POC due by 06/10/2026. Licensee will send a picture to LPA Holmes of reciept

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(3)(D) · Plan of correction due date: Jun 10, 2026

Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of:(D) Hygiene items of general use such as soap and toilet paper. This requirement was not met as evidence by: Based on observations and interviews, the licensee failed to provide paper towels for 6 out of 6 residents (R1-R6). This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 4, 2026

Plan of correction: Licensee will make sure that there are extra toilet paper and paper towels at the facility at all times. LPA Holmes observed several paper towel rolls at the facility during the visit. Licensee will purchase more paper towels to have extra by POC date of 06/10/2026. Licensee will send a picture to LPA Holmes of reciept

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: May 29, 2026

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidence by: Based on records and interviews the licensee did not provide healfull and comfortable accomodations in 1 of 6 persons in care(R1-R6) which posed a potential Personal Rights risk to persons in carethe state’s words, verbatim · CDSS document, Jun 4, 2026

Plan of correction: Licensee will turn the fans on early in the am to keep the facility cool. There AC at the facility is ran when it is really hot Licensee will go over with staff when to use ac and the fans. Licensee will send over written documentation that shows she spoke with staff about this. POC due 6/10/2026

Allegation investigated: Staff did not treat resident with dignity

Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to close out a complaint on the above-mentioned allegation. LPA gained access to the facility, identified herself, and met with Teresita Roxas, Administrator to discuss the purpose of the visit. LPA conducted conducted a tour of the facility, and conducted interviews. It was alleged that staff did not treat resident with dignity. Interviews revealed the staff members at the facility are wonderful and nice, however, there was an interview that revealed sometimes the owner says things like "there's the door" or "you can get out" Other interviews revealed that there are 3 staff members and that they are hard workers and treat the residents well. Interviews also revealed that the facility owner is very curt and won't greet residents or respond when they greet the owner. Based on the evidence obtained from interviews, the complaint allegation is substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. A deficiency is cited per Title 22 California Code of Regulation on the 9099 D page. An exit interview was conducted with Teresita Roxas, Administrator and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit. Substantiatedthe state’s words, verbatim · CDSS document, May 26, 2026 · control 08-AS-20250905085135

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Jun 12, 2026

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on interviews, the facility failed to treat 6 out of 6 residents with dignity.(R1-R6) This poses a potential personal rights violation to the clients in care.the state’s words, verbatim · CDSS document, May 26, 2026

Plan of correction: Licensee will have a training by an outside source on personal rights. POC due to CCL by 06/12/2026. Licensee will provide to LPA documentation of training and sign in sheet for all staff

Allegation investigated: Facility staff did not initiate medical assistance to resident timely Facility staff did not accord resident with dignity

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegations. LPA identified herself to, was greeted by, and explained the purpose of the visit to Caregiver Ofelia Fortunato. Administrator Teresita "Roxie" Roxas arrived during the visit. The Department’s investigation consisted of interviews with residents, staff, and outside sources, records review, and a tour of the facility. It was alleged that staff did not initiate medical assistance to Resident 1 (R1) in a timely manner and staff did not accord resident with dignity. Interviews with staff and outside sources revealed that sometime around 5:30pm on 4/26/2025, R1 began bleeding from a port on their arm. R1 provided conflicting information regarding the timing of the event and stated that the bleeding occurred in the early morning, however, the exact time could not be verified. Residents and staff stated that residents ring a bell to notify staff when residents need assistance. Continued on LIC9099-C page... Unsubstantiated Interviews revealed that R1 used a bell to alert staff that R1 needed assistance, however staff did not immediately respond to the bell, prompting R1 to ring the bell again and yell that they needed help. Staff 1 (S1) estimated that it was about a minute between R1’s first bell call and when S1 responded to R1’s room. Interviews revealed that S1 responded to R1’s room and made a comment stating that R1 was not the only resident requiring assistance and S1 could not immediately respond to R1’s calls. Interviews with staff revealed that two other staff were present at the facility who were not actively on shift during the incident. Interviews with staff revealed that once S1 observed that R1 was bleeding, S1 grabbed a towel to cover R1’s port to stop the bleeding and called 911. Interviews with S1 revealed that while S1 was on the phone with emergency services, one of the off-duty staff called the Administrator, which the Administrator confirmed during interviews. R1 was transported to the hospital via emergency services and returned to the facility on 4/29/2025. The Administrator stated that R1 was transported to the hospital within 15 minutes of S1 calling 911, however, other staff and residents were unable to provide a clear timeline of events between R1 beginning to bleed and when R1 was transported to the hospital. Interviews with staff and residents and medical discharge paperwork revealed that on 5/3/2025, R1’s port began bleeding again. Staff stated that S1 placed a towel on R1’s arm to stop the bleeding. Interviews with staff as well as review of S1’s personal cell phone call log revealed that S1 called 911 on 5/3/2025 at 9:43pm and the call lasted approximately 3 minutes. S1 stated that they stayed on the phone with 911 until emergency personnel arrived at the facility. Review of photographs provided to the Department by S1 revealed that emergency personnel were present at the facility at 9:57pm and medical paperwork revealed that R1 was admitted to the hospital at 10:38pm. Interviews did not provide the Department with a clear timeline of how long emergency services were present at the facility before transporting R1 to the hospital. Interviews with residents did not reveal concerns that staff were rude or spoke to residents inappropriately. Interviews with staff as well as review of progress notes revealed that R1 could be demanding and engaged in yelling and cursing behaviors. Staff also stated that R1 wanted assistance and requests for items or care answered immediately. The Department has investigated the above-mentioned allegations and based on interviews and records review, the preponderance of the evidence has not been met, therefore, these allegations are deemed unsubstantiated. An exit interview was conducted with Administrator Teresita "Roxie" Roxas, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 03/22).the state’s words, verbatim · CDSS document, Aug 8, 2025 · control 08-AS-20250505090137

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced case management visit to cite a deficiency identified during a complaint investigation that is unrelated to the complaint allegations. LPA identified herself to, was greeted by, and explained the purpose of the visit to Administrator Teresita "Roxie" Roxas. During the unrelated complaint investigation, it was determined that Resident 1 (R1) experienced a medical emergency and was sent to the hospital for treatment on 4/26/2025 and 5/3/2025. Interviews with the Administrator and review of documents received by the Department from the facility revealed that incident reports had not been submitted for either of those incidents. Therefore, a deficiency regarding reporting requirements is being cited per California Code of Regulations Title 22 and noted on the attached LIC809-D page. An exit interview was conducted with Administrator Teresita "Roxie" Roxas, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Aug 8, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Aug 15, 2025

87211 Reporting Requirements(a)(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events... This requirement has not been met as evidenced by: Based on interview and record review, the Licensee did not comply with the section cited above in that written incident reports were not submitted to the Department regarding R1's hospitalizations. This poses a potential safety risk for 6 of 6 residents in care.the state’s words, verbatim · CDSS document, Aug 8, 2025

Plan of correction: Administrator will review reporting requirements and submit a written letter stating that the Administrator has reviewed, understands, and will comply with reporting requirements and the incident reports for R1's hospitalizations to the Department by POC due date of 8/15/2025.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced case management visit to continue the annual inspection started on 7/30/2025. LPA was greeted by, identified herself to, and explained the purpose of the visit with Administrator Teresita "Roxie" Roxas. The facility is licensed for a maximum capacity of 6 non-ambulatory residents, 1 of which may be bedridden in a room with a direct exit. The facility has a waiver for 4 hospice residents. During today’s visit, the facility had a census of 6 non-ambulatory residents. The Administrator for the facility is Teresita Roxas and their certificate was valid and current. During visits on 7/30/2025 and 8/8/2025, LPA toured the facility and inspected each room of the facility, including resident rooms, bathrooms for resident and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed on the premises. LPA did not observe any aspects of delayed egress or secured perimeter. LPA observed an enclosed area located in the facility garage that the Administrator stated were two staff rooms. The Administrator stated that the area was an Accessory Dwelling Unit (ADU) and did not require a building permit due to its size. LPA was able to observe one of the rooms to contain a bed. Administrator stated that staff would use the rooms as a break area or to sleep after long shifts. The facility’s water temperature was measured at 106.7 and 107.6 degrees Fahrenheit in bathrooms for resident use. The facility’s internal temperature was measured at 76 degrees Fahrenheit. LPA observed an unlocked cabinet located in the backyard that contained cleaning chemicals and staff stated the cabinet was usually locked. Staff locked the cabinet prior to the end of the inspection. Continued on LIC809-C page… According to "Roxie" Roxas, no firearms or weapons are stored on the premises. LPA also observed locked storage for resident medications and resident and staff files. Resident medications are stored in their original container and labelled. LPA observed a minimum of a 2-day supply of perishable food and a 7-day supply of non-perishable food present at the facility. The facility refrigerator was kept at 32 degrees Fahrenheit, and the facility freezer was kept at -7 degrees Fahrenheit. LPA observed linens and hygiene products provided to the residents that are in good repair and sufficient to meet their needs. Staff present at the facility during the time of the inspection had a criminal background clearance and had a first aid certificate. LPA reviewed multiple resident and staff records. Each resident record was complete and contained a signed admission agreement, initial medical assessment, updated annual reappraisal, documents regarding safeguarding personal property and personal rights. Each staff file was complete and contained a personnel record, first aid certificate, fingerprint clearance and association, and a health screening. The following deficiencies were cited for unlocked cleaning chemicals and fire clearance and noted on the attached LIC809-D pages. Additionally, a civil penalty in the amount of $500 was assessed for fire clearance violation and noted on the attached LIC421IM form. Additionally, an LIC9102TV Technical Violation regarding clearance transfers and an LIC9102TA Technical Advisory regarding exception requests were provided. An exit interview was conducted with Administrator Teresita "Roxie" Roxas, whose signature below confirms receipt of a copy of this report, the LIC9102TA and LIC9102TV, LIC421IM and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Aug 8, 2025

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Administrator Teresita 'Roxie' Roxas. During today's visit, LPA observed residents in care, reviewed facility records, and spoke with staff and residents. LPA provided guidance and consultation with Administrator regarding regulation changes that became effective 1/1/2025. Due to time constraints, the annual inspection could not be completed and a return visit on a subsequent day is needed. No deficiencies were cited on today's date. An exit interview was conducted with Administrator Teresita 'Roxie' Roxas, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Jul 30, 2025

Allegation investigated: Facility staff locked resident in their room

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Licensee Teresita "Roxie" Roxas. The Department’s investigation consisted of interviews with staff and outside sources and a tour of the facility. It was alleged that facility staff locked residents in their room, specifically Resident 1 (R1). During an on-site visit to the facility on 8/17/2021, the Department observed a doorknob with a locking mechanism that was installed on a resident’s bedroom door that allowed the door to be locked from the outside of the room. During the onsite visit on 8/17/2021, the Department visually confirmed that the Licensee removed the doorknob with the locking mechanism during the visit. During interviews, the Licensee denied installing the doorknob or locking any residents in their rooms. Staff denied locking residents in their rooms during interviews, however, outside sources provided conflicting information. Continued on LIC9099-C page... Substantiated Multiple outside sources alleged that facility staff had made statements indicating that R1 was locked in their room when R1 was experiencing behaviors, including wandering and exit seeking. Interviews and interactions with facility staff revealed that facility staff, including the Licensee, were not truthful with Department representatives during interviews. The Department was unable to interview R1 due to R1 no longer residing at the facility. The Department has investigated the above-mentioned allegation and based on interviews and observations, the preponderance of the evidence has been met, therefore, this allegation is deemed substantiated. The following deficiency is cited per CA Code of Regulations Title 22 and noted on the attached LIC9099-D page. An exit interview was conducted with Licensee "Roxie" Roxas, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Jun 24, 2024 · control 08-AS-20210813081420

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(6) · Plan of correction due date: Jul 8, 2024

87468.1 Personal Rights of Residents in All Facilities (a) residents… shall have all of the following personal rights (6) … to not be locked in any room, building, or on facility premises by day or night… This requirement has not been met as evidenced by: Based on interviews and observations, the licensee did not comply with the above regulation in that residents were locked in their room, which poses a potential personal rights risk to 6 of 6 residents in care.the state’s words, verbatim · CDSS document, Jun 24, 2024

Plan of correction: Licensee removed locking door knob during visit on 8/17/2021. Licensee and staff will attend an outside vendor training on personal rights and will submit a sign in sheet to the Department by POC due date of 7/8/2024.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Licensee Teresita "Roxie" Roxas. The facility is licensed for a maximum capacity of 6 non-ambulatory residents, 1 may be bedridden in a room with a direct exit. The facility has a waiver for 4 hospice residents. During today’s visit, the facility had a census of 3 non-ambulatory residents, all of which were receiving hospice care. LPA did not observe any aspects of delayed egress or secured perimeter. The Administrator for the facility is Teresita "Roxie" Roxas and their certificate was valid and current. During today’s visit, LPA toured the facility and inspected each room of the facility, including resident rooms, bathrooms for resident and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed on the premises. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured at 113.7 degrees Fahrenheit in the kitchen sink and 119.5 degrees Fahrenheit in a private bathroom. The facility’s internal temperature was measured at 71 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. According to "Roxie", no firearms or weapons are stored on the premises. LPA also observed locked storage for resident medications and resident and staff files. Resident medications are stored in their original container and label. LPA observed a 2-day supply of perishable food and a 7-day supply of non-perishable food present at the facility. The facility refrigerator was kept at 40 degrees Fahrenheit, and the facility freezer was kept at 0 degrees Fahrenheit. LPA observed linens and hygiene products provided to the resident that are in good repair and sufficient to meet their needs. Staff present at the facility during the time of the inspection had a criminal background clearance, were associated to the facility, and had a first aid certificate. Continued on LIC809-C page… LPA reviewed multiple resident and staff records. Each resident record was complete and contained a signed admission agreement, updated physician’s report and medical assessment, documents regarding safeguarding personal property, and personal rights. Each staff file was complete and contained a personnel record, first aid certificate, fingerprint clearance and association, and a health screening. LPA spoke with staff and esidents present at the facility during the time of the inspection and those interviews did not reveal any licensing or regulatory concerns. The Licensee will submit copies of the LIC500 Personnel Report, LIC610E Disaster Plan, and current liability insurance to the Department within 15 business days. No deficiencies were cited on today’s date. An exit interview was conducted with Licensee "Roxie" Roxas, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Apr 22, 2024