Routine inspection·May 15, 2025

On May 15, 2025, Licensing Program Analyst (LPA), Deborah Lee conducted an unannounced annual required visit using the CARE Inspection Tool. LPA Lee met with Jun Fausto Figueroa and the purpose of today’s visit was explained. The facility is licensed to serve 6 elderly adults ages 60 and above, of which 6 can be non-ambulatory. The facility has an approved hospice waiver for (4). A total of 6 residents are currently residing in this facility. Physical Plant/Structure : The facility is a one-story residential home consists of 6 resident bedrooms, (2) resident bathrooms, living rooms, dining room, kitchen, staff room, office area, storage area, attached garage washer and dryer room, backyard with table and chairs. LPA Lee and the Administrator toured the physical plant. There were no bodies of water or obstructions on the premises. Bedrooms: LPA inspected all 6 bedrooms; the mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Page 1 of 3 Bathroom s: Toilets and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries accessible to residents. LPA tested hot water temperature, and it measured between 105 and 120 degrees Fahrenheit. This facility Common Rooms: All common areas are clean and free of obstructions. There is adequate seating for the residents in care. Each common area is equipped with furniture that is in good repair. Required Postings: LPA observed all required documents posted throughout the facility. The facility has a working landline telephone. Kitchen LPA observed a 2-day supply of perishable foods, and a 7-day supply of non-perishable foods properly stored, packaged, and labeled. Safety LPA observed 2 fully charged fire extinguishers last serviced on 02/26/25 The last emergency drill was conducted on 4/18/25. Smoke detectors were test and operational. File Review: LPA reviewed 6 resident files and found that ( 6 ) out of ( 6 ) had the required documents. LPA reviewed 4 staff files and found that ( 4 ) out ( 4 ) had the required documents, training, and certifications. Page 2 of 3 Medications LPA observed all centrally stored medications secured All medications were observed in their original packaging. LPA reviewed a copy of the facility’s Liability Insurance with expiration date of 9/20/25 Infection Control LPA observed required infection control signs posted throughout the facility. LPA observed a sanitizing stations in entryway of facility. LPA observed an ample supply of PPE supplies. During today’s visit 1 citation issued see 809D An exit interview was conducted with Jun Fausto Figueroa, Administator. and a copy of this report was provided. Appeal Rights given to Administrator. Page 3 of 3