Routine inspection·January 30, 2025

On 1/30/2025 Licensing Program Analyst (LPA) M. Garza arrived unannounced for an annual inspection visit. LPA was met by Administrator, Karley Alcantar. LPA introduced self, explained reason for visit and was permitted entry into the facility. LPA completed a health and safety check on residents in care. LPA toured the facility inside and out. Sample resident rooms were observed. There was 5 resident on hospice at the time of the inspection. Pathways and doors were clear and free from obstruction. Common areas were clean, adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operate on a system. Smoke/carbon monoxide detectors present and operational in independent living. Fire extinguishers last serviced 3/14/2024. Last fire drill on 12/20/2025. Resident rooms observed to have the required furnishings and with adequate lighting. Linen supplies are kept in linen closets. LPA observed sufficient seating under covered patio areas. The following issues were observed during todays visit: Trash can in restrooms not covered. Food in freezer inside snack area not properly stored. Snack area was observed with cabinet full of debris in need of cleaning and a hole needing repair under sink. Beverage servers/ice dispenser in snack area and kitchen galley observed dirty, in need of cleaning. White sputum observed in hallway in need of cleaning/disinfecting. Trash can observed in kitchen galley observed without lid. Food in kitchen refrigerator observed not properly stored and in need of disposal. Kitchen doorway observed with broken tile/laminate in need of repair/replacement. Tools/items posing a danger observed outside off kitchen unlocked and accessible. Trash cans off kitchen observed overflowing and in need of disposal. CONT... CONT... LPA requested the following documents to be submitted to CCL by 2/7/25: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-E), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file. Due to facility size and time frames, LPA will return for an annual continuation visit. Exit interview completed with Administrator, Karely. A copy of this report, deficiencies and appeal rights were provided.