North Lake Villas Inc..

Licensing Program Analysts (LPAs) Antonia Alvizar-Ettima and Huma Rahimi conducted an unannounced annual inspection visit at this facility. LPAs met with staff Office Assistant and Office Assistant who called the Assistant Administrator and explained the reason for the visit. The Assistant Administrator arrived about thirty (30) minutes later and joined LPAs. LPAs utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today. A tour of the physical plant was conducted at 10:10AM with Resident Care Coordinator/ Med-Tech and Assistant Administrator for compliance with safety, maintenance and operational requirements. The following was noted: Facility is a single-story residence in a residential community. The facility has fifteen (15) bedrooms and nine (9) bathrooms in multiple interconnected residential type building. The facility is fire cleared for thirty (30) non-ambulatory residents, twenty-three (23) of which maybe bedridden in rooms 1 to 15. Hospice waiver for ten (10) residents. Living and dining rooms furniture were checked. The living rooms were neat, clean and in proper order. The facility maintains a comfortable temperature at 74°F. The smoke/carbon monoxide detectors are duel hardwired interconnected and observed to be operational. Fire extinguishers are located all throughout the facility and last inspected on 12/30/25. The facility is equipped with sprinkler system. Fire inspection including alarms and full fire inspection was last done on 12/30/25. Passageways were observed to be clear from obstruction. (Cont. on LIC 809-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 (Cont. from LIC 809) Laundry area is located in the lower level. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet inaccessible to the residents. The kitchen appeared to be clean and the appliances and fixtures functional. This kitchen is used to prepare and cook all meals for residents in care. LPAs observed a sufficient amount of perishable and non-perishable food at the facility; properly stored in the lower level area of the facility. Sharp objects are stored and locked in a drawer in the kitchen. The residents’ rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lit. The bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the showers and toilets. Residents have sufficient amounts of supplies for personal hygiene. The hot water was measured at 111. 7-degree Fahrenheit within title 22 regulations. Medications were kept in a medication cart located in the medication room adjacent to the kitchen. The medications were observed to be locked and inaccessible to residents. There were two (2) complete first aid kits located in the medication room. The surrounding grounds (outdoors) were well landscaped and a covered patio with proper furniture for residents outdoor use. There are no bodies of water on the premises. Staff records were reviewed. Staff present have criminal record clearances and associated to this facility. Staff records appear to be complete and current. Resident records were also reviewed and appeared to be complete and current. There is no health and safety issue observed during this visit. Exit interview conducted. A copy of this report was provided.

Licensing Program Analysts (LPAs) Gary Tan and Antonia Alvizar-Ettima conducted an unannounced Required One (1) year inspection at this facility. LPAs met with staff Maria Heredia who called the administrator and explained the reason for the visit. The Assistant Administrator Adam Braun arrived forty (45) minutes later. A tour of the physical plant was conducted at 9:48 AM and the following was noted: There is only one entrance being utilized at the facility, there are required posters posted at the main door. Screening area is located immediately upon entrance. Sign in sheet and hand sanitizer is available. The facility had submitted and approved Mitigation Plan and Infection Control Plan. Signs of COVID-19 prevention protocol were posted inside. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has multiple screening stations all through out the facility. The facility has sufficient stock of PPE in the storage. The facility has fifteen (15) bedrooms and nine (9) bathrooms in multiple interconnected residential type building. The facility is fire cleared for thirty (30) non-ambulatory residents, twenty three (23) of which maybe bedridden in rooms 1 to 15. Hospice waiver for ten (10) residents. Living and dining rooms furniture were checked. The living rooms were neat, clean and in proper order. The facility maintains a comfortable temperature at 75°F. The smoke detectors are hardwired and interconnected and observed to be operational. There are carbon monoxide detectors installed in the facility. Fire extinguishers are located all throughout the facility and last inspected on 11/08/23. The facility is equipped with sprinkler system. (continued to LIC 809-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 (continued from LIC 809) Fire inspection including sprinkler inspection, alarms and full fire inspection was last done on 12/29/23. There is no body of water at the facility. Passageways were observed to be clear from obstruction. Laundry area is located in the lower level. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet inaccessible to the residents. Food Service/Kitchen area was sufficiently stocked with two (2) days of perishable and seven (7) days of non-perishable food. Knives and sharp objects were observed to be locked and inaccessible to residents. The residents rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passage ways are lit. The bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the showers and toilets. The hot water temperature was measured at a range of 105.1°F to 116.5°F. There were enough clean linen available in the closets. Medications were kept in a medication cart located in the medication room adjacent to the kitchen. The medications were observed to be locked and inaccessible to residents. There were two ( 2) complete first aid kits located in an office adjacent to the kitchen. Staff records were reviewed. Staff present has criminal record clearances and associated to this facility. Staff records appear to be complete and current. Resident records were also reviewed and appeared to be complete and current. Disaster drill was last conducted on 07/16/24. Required posting are observed to be complete and current and displayed properly at the facility. There is no health and safety issue observed during this visit. Exit interview conducted. A copy of this report issued.