Routine inspection·September 14, 2025

On 9/14/2025 at approximately 09:4(5AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by staff and stated the reason for their visit. The Co-Administrator, Jeffrey Ezros arrived shortly after to assist with today’s visit. LPA asked for the census, Staff/Resident Roster, and Liability Insurance. LPA conducted a physical plant tour at approximately 1:00 PM and the following was noted: The facility is a single-story building with six (6) bedrooms and six (6) bathrooms. The facility is currently occupying six (6) residents. There is a designated staff office. The facility has an approved fire clearance for six (6) non-ambulatory residents. Hospice waiver approved for four (4). Common areas: The living room and dining room were observed to be neat, clean, and organized. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 74°F. LPA observed a fire extinguisher to be located underneath the kitchen sink and dated 09/14/2025. LPA observed required postings such as Long-Term Care Ombudsman, Emergency Disaster Plan, and Personal Rights to be located throughout the common areas. A working telephone was observed. Kitchen: The kitchen was observed to be clean and free from pests. Sufficient supplies of seven (7) day nonperishable foods and two (2) day perishable foods were observed. Knives/sharps were observed to be kept in a locked kitchen drawer. The cleaning solutions/toxins were observed to be kept locked underneath the kitchen sink. Kitchen appliances were observed to be working and in proper condition. (continued on LIC 809-C) Bedrooms: The residents’ rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. Extra linens/covers were observed to be stored in each resident’s room and a storage dresser located within the hallway’s passageway. Bathrooms: The bathrooms were checked for cleanliness and proper operation. The hot water temperature was measured within regulations. LPA observed appropriate grab rails and slip-resistant mats to be in proper condition. Backyard: The backyard of the facility is equipped with a designated shaded area with outdoor furniture for residents. LPA observed there to be a pool. LPA observed the pool to properly fenced and locked. Garage: The garage is located outside in the backyard separate from the facility. The garage was observed to be kept locked and used for storage purposes. Laundry Room: The laundry appliances were observed to located within the garage. LPA observed cleaning solutions and toxins stored appropriately within the garage and inaccessible to residents. The laundry appliances were observed to be working and in proper condition. Medications: The medications were observed to be kept locked in a storage closet. First-aid kit observed to be equipped with but not limited to bandages, scissors, digital thermometer, tweezer and First-Aid Manuel. Smoke detectors and carbon monoxide observed to be working properly and were tested. Staff Office: The staff and resident files are kept in the staff office. LPA observed the staff office to be kept locked. Residents/Staff Records: LPA conducted a complete file review of resident records. Resident records appeared to be complete and updated. Staff records: LPA conducted a file review of staff records. LPA observed one (1) of five (5) staff members (S2) not to have fingerprint clearance. Further record review revealed S2 did not have a personnel record. LPA observed the staff member (S2) to be working and helping residents. Per the Co-Administrator, S2 had just begun to work at the facility. The Co-Administrator stated they would be taking S2 this week to get their fingerprint clearance. LPA’s record review of The Department of Social Services Guardian and Licensing Information System (LIS), confirmed S2 was not associated nor cleared to work within the facility. Additionally, LPA observed one (1) of five (5) staff members not to have their Health Screening Report with their tuberculosis screening. (Continue to LIC 809-C) Citation issued, please refer to LIC 809-D A civil penalty for $100 per day for a maximum of 5 days in the amount of $500 for criminal record clearance violation is being assessed on the attached LIC 421BG. There were no other immediate health and safety hazards observed during the day of inspection. Exit interview conducted, Appeals Rights given, and a copy of this report was provided to the Co-Administrator.