Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Case Management Deficiencies in conjunction with a pre licensing visit (pending license # 198603903 ). The purpose is to issue deficiency that was observed by LPA.

During the visit on 06/29/2026, applicant and administrator confirmed that they have (20 bedridden residents in house and but fire clearance is approved for (6) non ambulatory residents, where (1) can be bedridden in Room #6. However, LPA observed (1) bedridden female resident in Room #4. This additional bedridden resident is not approved or cleared by the fire department/fire marshall.

Deficiency is noted on LIC 809D. Exit interview, a copy of this report and Appeals Rights were provided to

Lilyvi Santos, Care Staff and Shelly Yamashiro, Administrator.