Routine inspection·January 18, 2024

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Adriana Garcia and explained the reason of the visit. The facility is licensed to serve 9 non-ambulatory residents ages 60 and over, and has an approved Hospice Waiver for no more than 5 residents. Facility has a Dementia Program in place and a Food Service Waiver to prepare food off premises and transport to the facility. The facility is a single home in a residential area, with a kitchen, living room, dining room, entry area, sun room area, 5 bedrooms 4 bathrooms, visitor's/staff bathroom, laundry area, an detached garage, front court, and a backyard area. LPA Flores conducted a tour of the facility with Adriana Garcia and observed the following: Facility's indoor and outdoor is in good repair. Living room, dining room, sun room area have sufficient sitting area, are clean, and in good repair. Kitchen is clean, snacks were observed, and daily food is refrigerated. Medication cabinet was observed locked. Laundry room is inaccessible to the residents and cleaning supplies, knives are stored here. Resident's rooms (5) have the required furniture, bedding supplies and sufficient lighting. Bathrooms (4) in resident's rooms are in working condition, have grab bars, and skid mats. Water temperature was tested in each, between 105.2 - 112.6 degrees F. Fireplace located in living room and in 2 resident's rooms are covered. Emergency food supplies, water, and a generator were observed in the garage. Facility has a fire sprinkle system throughout. Fire extinguishers were observed throughout the home and last checked on 2/2/7/23. Carbon Monoxide detectors were observed. Fire Department Inspection report was last conducted on 4/6/23. Backyard and passageways were observed clean, and free of obstruction/debris. A copy of Liability Insurance was obtained. LPA reviewed Infection Control plan, and Emergency Disaster Plan both reviewed yearly by facility staff. LPA reviewed medication and files for 5 residents and 5 staff files. Staff #5(S5) was hired on 12/30/23 and health screening is pending. No Deficiencies were noted today. Exit interview was conducted with Claudia Romero Manager and a copy of this report was provided.