Routine inspection·September 3, 2025

On September 3, 2025, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with administrator Ivan Bravo and explained the purpose of today’s visit. The facility is licensed to operate for six (6) elderly residents non-ambulatory ages 60 and above. The facility consists of the following: four (4) resident rooms downstairs with two bathrooms, living room, dining room, kitchen, outside laundry room. The second floor consists of three (3) staff bedrooms, an office, and spare room. LPA and administrator toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 105.1-degree F. A comfortable temperature of 77-degree F. was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Evaluation Report Continues LIC 809-C Fire extinguisher was charged, smoke detectors and carbon monoxide were operable. The last fire drill conducted on 07/01/25. A landline telephone was in working condition. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. All mandated inspection control posters were posted. The facility has current liability insurance on file effective 03/28/25 through 03/28/26 policy #0100291673-1. An audit of residents #1-#2 (R1-R2) service files were complete, and staff #1-#2 (S1-S2) maintained in order and had all the required licensing records. The facility is not current with Community Care Licensing Annual dues with an open balance $495. The facility has a current Administrators Certificate on file for Ivan Bravo #7005889740 - 08/08/2024 through 08/07/2026. Deficiencies: LPA audited the personnel records of Staff #1 and Staff #2 and found that they did not have current CPR/First Aid Certificates on file; both certificates expired in 2015 and 2017, respectively. Additionally, LPA identified that both Resident #1 and Resident #2 were using full bed rails, yet neither was on hospice care nor had a physician's prescription on file authorizing their use. Upon reviewing the service file for Resident #2, who is diagnosed with (NCD), LPA noted that there was no current Resident Appraisal available. The last appraisal documented was from 2018. Deficiencies are listed on LIC 809-D An exit interview conducted with Ivan Bravo and a copy of report and appeal rights were provided.