Routine inspection·December 13, 2023

On 12/13/2023 at 9:10 AM, Licensing Program Analyst (LPA) P. Watson arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Administrator , Liezyl Ajos and explained the purpose of the visit. The facility’s fire clearance was approved for 6 Non-Ambulatory. LPA toured facility with Liezyl including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms which 3 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 75 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 within range of 105-120 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. First aid kit was observed to be complete. Fire extinguisher was last serviced on 10/11/2023. Report continues on 809 C At 9:25 AM, LPA reviewed 4 of 4 residents records. At 10:00 AM, LPA reviewed 4 staff records and 4 of 4 have current first aid training and associated to the facility. At 10:50 AM, LPA reviewed a sample of 4 of 4 resident’s medications. Updated copies of the following documents were requested for facility file and are to be submitted to CCL via fax by 12/27/2023: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (9 page version) Liability Insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.