Routine inspection·February 20, 2025

On 02/20/25, Licensing Program Analyst (LPA) M Vega arrived at the facility unannounced to conduct Required Annual Inspection. LPA was greeted by receptionist and stated the purpose of the visit. LPA met with Executive Director (ED) - Brandon Montelongo. LPA conducted tour of facility with ED. Residents were observed throughout the facility post lunch. Some residents were in the main lobby area playing bingo as well. The facility was observed to be at a comfortable temperature, 72-75 degrees Fahrenheit throughout the facility. The facility was observed to be clean, in good repair, and no passageway obstructions or fire hazards observed. Fire extinguisher was observed with a service date of 02/03/2025 - 29/100. Dining area and Kitchen were toured. An adequate supply of perishable and non-perishable food was observed to be properly stored in walk-in freezer, walk-in refrigerator, and pantry. Refrigerator temperature was maintained at 40-degree F. and freezer was maintained at -5-degree F. LPA toured a sample of resident bedrooms. Residents' rooms were toured and observed with adequately furnished with bed, dresser, and adequate lighting. LPA toured laundry room and observed chemicals were stored and locked. Hot water temperature tested at 120 degrees F. LPA observed securely fastened grab bars and non-skid mat in all shower areas. Medications were stored in a locked medication room in a medication cart. Medications records were reviewed to be accurate at time of inspection. Report continued LIC 809C Facility courtyard was toured and observed to be free from debris. There was outdoor seating available for the residents. A sample of residents’ file was reviewed to have updated files. A sample of staff files were reviewed. Staff files were observed to have current records. Staff are fingerprinted clear and associated to the facility. LPA requested following files: LIC 308 Designation of Facility Responsibility LIC 309 Administrative Organization LIC 400 Affidavit Regarding Client/Resident Cash Resources LIC 402 Surety Bond LIC 500 Personnel Report LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly LIC 9020 Register of Facility Clients/Residents Copy of current Liability Insurance Copy of current Administrator Certificate Alternate contact information including name, telephone number, & email address. An exit interview was conducted with the ED. No deficiencies issued during this inspection. A copy of this report was provided to the ED, whose signature on this form confirm receipt of this report.