Routine inspection·August 27, 2025

On 8/27/2025 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct a required Annual Inspection. Upon arrival LPA was greeted by the Administrator Estela Monderin, who granted access to the facility. LPA introduced herself by showing her badge and explained the reason for the visit. LPA Khurshudyan reviewed the required postings on the hallway wall next to the kitchen area. The inspection tool was used to complete the visit. At 9:45am LPA jointly with the Administrator began a physical plant tour of the facility and the following was observed: This is a single-story building with four (4) bedrooms, all rooms designated for residents’ use and one staff bedroom designated for staff use only. There are two (2) bathrooms, kitchen, common areas: living and dining rooms, and outdoor areas. Facility has an approved fire clearance for five (5) Non-ambulatory residents. The facility also has a Hospice waiver for five (5) residents. Common Areas : The facility maintains a comfortable temperature at 78°F. The living room and dining area appeared generally clean and were properly furnished. No obstructions and or tripping hazards throughout the facility were observed. Kitchen: At approximately 10:20am LPA toured the kitchen area and observed enough supplies of non-perishable for minimum 1 week and perishable food for 2 days at the facility. Sharps/knives were properly stored and locked inside the kitchen cabinet. There is a fire extinguisher on the kitchen countertop, which was last serviced on 7/10/2025. Chemicals observed to be locked under the sink and inaccessible to residents in care. Continue on LIC809-C Bathrooms: At 10:30am LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet paper, soap and paper towels. The hot water temperature measured at 110.8°F. LPA observed appropriate grab bars and non-skid mats. All trash cans in bathrooms had fitted lids to protect from cross contamination. Smoke detectors/carbon monoxide . Dual smoke and carbon monoxide detectors were located throughout the facility, and at 11:35am they were tested and observed to be operational. Outside areas: At approximately 11:40am LPA toured the outside area of the facility and observed appropriate outdoor furniture, with a covered shaded area for residents. LPA discussed the importance of maintaining care and supervision to meet the needs of residents. There are no bodies of water. Laundry Room: Laundry machines are placed outside of the property. Disinfectants, laundry detergents and hygiene supplies were stored and inaccessible to residents in care. Extra linens were stored in a separated linen closet and readily available. Garage: There is no garage in the property. Between 10:35am to 12:00pm, LPA reviewed records of three (3) residents and four (4) staff members. Resident and staff records appeared to be complete and updated. MEDICATION: LPA observed centrally stored medication and First Aid kit locked inside the closet located in the hallway next to bathroom #1, and inaccessible to residents in care. LPA observed First-aid kit is complete and has new manual. Facility has a Dementia Care Program. PRN medications have written orders from a physician. The facility serves residents with dementia and the facility has trained staff to meet the needs of residents who are diagnosed with dementia. Facility has two (2) staff for AM shift and two (2) awake caregivers for PM shift, there is one (1) caregiver on call. Administrative: Annual fee is current. All required signs are posted. LPA collected LIC500, LIC9020, and Certificate of Liability Insurance renewed on 8/23/2025. The Administrator Certificate expires on 2/6/2026. LPA Interviewed three (3) caregivers and one (1) out of three (3) residents who was able to communicate. No citation issued during this visit. Exit interview conducted. Copy of this report signed and delivered to the Administrator.