Routine inspection·September 12, 2022

On 09/12/2022, Licensing Program Analyst (LPA) Don Senaha conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA was met by Administrator Cipriana Archeta and explained the purpose of today’s visit. The facility is licensed to serve six (6) elderly residents ages 60 and above who are non-ambulatory. The facility has a hospice waiver for one (1) resident. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident's rooms, one (1) staff room, two (2) bathrooms, living area, dining area, kitchen, and outside patio area covered with an umbrella and ample seating in backyard. There were two (2) residents in the facility at the time of the visit. LPA and Administrator Cipriana Archeta toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were operational. The water temperature measured between 110.3 F and 120 F in the kitchen sink and bathrooms. There is an attached garage with access to garage from a door prior to entering the facility or through the garage door. The washer and dryer is located in the garage. There is also a second refrigerator/freezer and a third freezer located in the garage. The garage is used for storage and no cars are parked in the garage. Evaluation Report Continues on LIC 809-C LPA observed the facility to be appropriately furnished at the time of visit. LPA observed cleaning supplies and toxins were unlocked and accessible to resident. See 809D page. The kitchen was inspected and there is sufficient perishable and non-perishable food available and properly maintained. There is one (1) fire extinguisher fully charged in the kitchen area. Smoke detectors and carbon monoxide were tested. One smoke detector in room #2 was non operational. See 809D page. There was a first aid kit available stored in the kitchen. During the visit, LPA observed the facility infection control practices. LPA observed all mandated inspection control posters were posted. Advisory Notes – Five (5) Technical Assistance were issued, please see LIC9102-AN. There were seven (7) deficiencies cited during this inspection visit. See 809D pages. An exit interview was conducted and a copy of this report was provided to Administrator Cipriana Archeta.