Routine inspection·August 27, 2025

On 08/26/2024 around 10:00 AM, LPA L Holmes arrived unannounced to conduct a required annual inspection. The Care Staff telephone and Elisa Empig, Designated Responsible Party (S1) and explained the purpose of the visit. S1 arrived about 10 minutes later. LPA and S1 toured the facility including but not limited to the common areas, dining room, bathrooms, kitchen, bedrooms. The facility consists of five (5) residents two (2) were dining and the others in their rooms and watching television. Outdoor and indoor passageways were free of obstruction. There were not any bodies of water present. A comfortable temperature was maintained at 71 degree s Fahrenheit (F). LPA observed lighting in all areas to be adequate for the comfort and safety of the residents. The hot water temperature in the shared restroom was measured at 110.5 degrees (F). The shared restrooms had paper towels, soap and garbage cans; all areas were safe and sanitary. PPE, sanitizer, and paper goods remain sufficient. There is a 2-day supply of perishable foods and a 7-day supply of non-perishable foods. ...continued on LIC9099C. ...continued from LIC9099. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was observed full and serviced 06/24/25. Emergency Disaster Plan is updated. Safety drills are rotational between quarters. LPA reviewed three (3) staff files, and five (5) resident files; all files are complete. The following forms are to be updated by 09/05/25: -LIC500 Personnel Report (Reviewed) -LIC308 Designation of Administrative Responsibility (Reviewed) -LIC610E Emergency Disaster Plan (Reviewed) -Resident Roster (Reviewed) Exit interview conducted and a copy of this report provided to Care Staff, Cecelia Del Moral