Routine inspection·May 8, 2025

On 05/08/2025 at 11:00 AM, Licensing Program Analyst (LPA) Carol Fowler arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Sara Garcia and explained the purpose of the visit. Victor Rodriguez arrived at 11:10AM. Julio Alexander Administrator arrived at 12:00PM The facility’s fire clearance was approved for Six (6) in which all may non-ambulatory of which One (1) may be Bedridden in Bedroom #2. Hospice waiver for Three (3). Administrator Certificate #7002003740 expires 01/28/2026. LPA toured facility with Annette including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms which 6 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 105.8 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. LIC809-C Continued... LIC809-C Continued... Smoke and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 06/19/2023. Emergency Disaster Plan was last posted on 04/01/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 05/01/2024. LPA reviewed 5 residents records. LPA reviewed 5 staff records and 5 of 5 have current first aid training and associated to the facility. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 05/16/2025: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report Liability Insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.