Routine inspection·January 19, 2023

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced annual visit at the facility with focus on infection control domain, medication, and food review. LPA Flores met with Claudia Romero facility's manager and explained the reason for the visit. The facility is licensed to serve 9 non-ambulatory residents and has an approved Hospice Waiver for 2 residents. There is also a Dementia Program in place and a Food Service waiver to prepare food off premises and transport to the facility. The facility is a one single home with a kitchen, 5 private bedrooms 4 bathrooms; separate detached laundry area, an attached garage and backyard area. LPA Flores conducted a tour of the facility with Claudia Romero Manager and observed the following: Facility is clean and in good repair. Snacks were observed in kitchen's pantry and refrigerator. Cleaning supplies and sharps are kept in laundry room which is under lock. Medication is lock in kitchen's cabinet. Each resident bedroom was observed with sufficient lighting, the required furniture, and bedding supplies. Bedroom #3 has a covered fireplace. (4) resident bathrooms were observed, each with a skid mat, grab bars, and in working condition, water temperature was tested in each resident bathroom and tested between 107.2 - 113.7 which is within the required 105-120 degrees F. Living room area has a cover fireplace. Facility has a fire sprinkler system throughout the facility. Fire extinguisher is located across from kitchen entrance and in hallway outside bedroom #1 last checked on 2/28/22. Outdoor patio has a shaded sitting area. Facility is following infection control procedures. Signs were observed throughout the facility. Per administrator N95 mask fit testing has been schedule and will email the results of the staff that will provide direct care. LPA reviewed medication and files for 3 residents and files for 3 staff. A copy of liability insurance was requested. No deficiencies were noted during this visit. Exit interview was conducted with Claudia Romero Manager and a copy of this report was provided.