Routine inspection·August 18, 2025

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual inspection visit using the CARE tool. LPA met with Fe Abejo Caregiver and explained the reason for the visit. The facility is licensed to serve (6) elderly residents age 60 and above of which all may be non-ambulatory, and a hospice waiver for (3). The facility is located in a residential area and consist of a single home with a kitchen, dining room, living room, (3) resident bedrooms, (2) bathrooms, an office space, staff room,laundry/storage space, and a backyard. The following domains were reviewed during this visit: Infection Control : Facility maintains a copy of infection control and was last reviewed on 7/1/25. All staff have a TB clearance. Operational Requirements: Facility maintains a plan of operation, infection control plan, fire clearance. Facility is operating within the limitations of their license. They currently don't have residents under hospice care. A current liability insurance was observed and a copy was obtained. Physical Plant/Environmental Safety: LPA toured the facility with Fe Abejo caregiver and observed the following. Facility was observed in good repair. Living room has a fireplace with a metal cover and it is furnished. Dining room was observed with furniture and in good repair. Kitchen was observed clean, a large pair of scissors was observed in a small drawer without a lock which was moved by staff to a drawer with a lock which was unlock at the time of the visit were knives and sharps are stored. Refrigerator/freezer and pantry were observed. Medication cabinet is located in the kitchen area. Passage ways were observed clear of obstructions. Back porch and side porch were observed with old furniture clutter around, A ripped chair cushion chair was also observed. Garage space has been converted into an office space, a staff room, and laundry/storage area. (CONT. 809C) Three (3) resident rooms were observed with sufficient lighting, required furniture and bedding supplies. Room #1 and #2 were each observed with one bed with two half bed rails combine making it a full bed rail, and a bed with a full bed rail and Room #3 was observed with 3/4 bed rails in each bed. Door in bedroom #2 leading to a passage way which exits the facility did not have a sound device. Sound device was not working at the time of the tour on door exiting to back porch which leads to outside passageway. Two (2) bathrooms were observed in good repair, however shower floors were observed with soap buildup and mold in the corners. Water temperature was tested in each bathroom sink and tested between 112.8-114.2 degrees F., which is within the required 105-120 degrees F. There are no large bodies of water at the facility. Carbon Monoxide/Smoke detectors were tested and are in working condition. A fire extinguisher was observed. Staffing: Administrator certificate was reviewed for Linda Renard #7008248740 exp. date: 5/3/25. CPR/First aid training was observed for staff. A living staff is on duty during the night shift. Personnel Records/Staff Training: LPA reviewed 5 staff files. Files were available for review. Files include; TB clearance, health screening, background clearance, personnel record, and training for each staff. Two staff were interviewed. Resident Rights/Information: License, Let us Know (PUB 475), Ombudsman, personal rights posters were posted in the entrance of the home. Planned Activities: Facility provides activities such as board games, puzzles, books and music and crafts provider. Food Services: Although LPA did not observed a variety of food supplies, facility has at least 2 days of perishables and 7 days of non- perishable food supplies. An additional refrigerator was observed in the storage area. Kitchen was observed clean and free of pest. Cleaning supplies were observed stored in storage space. Staff were observed practicing hygiene and infection prevention. Four out of five residents have a modified diet per medical assessments. Incidental Medical and Dental: Facility provides assistance with medical/dental arrangements and with medication assistance. Medications were observed stored in locked medication cabinet. LPA reviewed medication for 5 residents. Resident Records/Incident Reports: LPAs reviewed 5 residents files, each contained admission agreement, medical assessment, TB clearance, pre-appraisal, and appraisal, 3 out of 5 residents did not have a medical assessment within the last 12 months. Three residents were interviewed. Disaster Preparedness: LPAs reviewed emergency disaster plan LIC 610E(3/19) last reviewed on 7/1/25. Emergency drills are conducted quarterly, last emergency drill was conducted on 7/2/25. (CONT. 809C) Residents with Special Health Needs: Facility is only serving 1 resident on Home Health Care, no bedridden, no hospice residents. Assistant Administrator Iren Creighton notified LPA that the facility is going under a change of ownership. Deficiencies are noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Iren Creighton Assistant Administrator and a copy of this report, LIC 809D, and appeal rights were provided.