Routine inspection·September 17, 2025

Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced one (1) year inspection at this facility. LPA met with Licensee, Administrator and explained the reason for the visit. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: At 10:45a.m. LPA and Administrator conducted a physical plant tour of the facility. The facility has one main entrance being used. Required posting are observed to be complete, current and displayed properly. The facility has an approved mitigation and infection control plan on file. The facility is a single-story building and has four (4) bedrooms and three (3) bathrooms located in a residential community. Three (3) bedrooms are double occupancy designated for residents, and one (1) bedroom is designated for staff use. The facility is Fire Cleared for four (4) non-ambulatory residents, one (1) of which maybe bedridden and two (2) ambulatory residents. Hospice waiver for three (3) residents. Smoke detectors and carbon monoxide are hardwired, interconnected and tested for proper function. Fire extinguishers were last purchased on 05/03/2025 and observed fully charged. The most recent disaster drill was conducted on 09/05/2025. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors were inspected. They were found clean and good repair. The facility maintains a comfortable temperature at 73°F. Cont. on LIC 809-C Cont. from LIC 809 Living and dining room furniture were checked. Furniture in the living and dining rooms was observed in good repair, clean and free of hazards. Both areas were appropriately furnished and provided a comfortable environment for residents. Resident rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lit. Residents have sufficient amounts of personal hygiene products which are provided by the licensee. Bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet and shower. The hot water temperature measured at a range of 106.3°F to 118.0°F. Towels and washcloths are not shared. There are enough clean linen available in stock in the linen cabinet located in the hallway. Food Service / Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Food storage and preparation areas are clean. The kitchen appeared clean and the appliances and fixtures functional. Knives and sharps are observed to be kept in the kitchen cabinet locked and inaccessible to residents. Medications : LPA observed medication in the kitchen locked cabinet and inaccessible to residents. First Aid kits are observed to be with complete tools and supplies. Laundry room is located at the side of the facility with no access from inside. The laundry room was observed to be locked and inaccessible to residents. Cleaning agents, toxins and detergents were secured. Garage is detached, locked, and inaccessible to residents. Garage is used as storage for supplies, tools and extra frozen food. Backyard of the facility has outdoor furniture, with a shaded area covered available for residents. The front and backyard passageways were clear of any obstruction. There is no body of water at the facility. Staff records were reviewed. Staff present had criminal record clearances and associated to facility. Staff records appear to be complete and current. Resident records were reviewed. Resident’s records appeared to be complete and current. There is no health and safety issue observed during this visit. Exit interview conducted. A copy of this report issued.