Routine inspection·June 11, 2024

On 06/11/24, 8:45 AM Licensing Program Analyst, (LPA) Raymond Comer, conducted an unannounced Annual visit to this facility. LPA met with caregiver who contacted the Facility Administrator, Brian Rosales, and reason for the visit was disclosed. Facility is licensed as a one story residence, with kitchen area at sub-floor level, fire clearance for eleven (11) non-ambulatory, of which, eleven (11) may be bedridden. Hospice waiver for eleven (11). At the time of this inspection, Facility has two (2) residents receiving hospice services. Facility has nine (9) resident bedrooms and ten (10) bathrooms. At 9:25 AM , LPA conducted a tour of the physical plant with the Administrator and observed the following: Physical plant was inspected for cleanliness and condition . Facility’s main door is the primary entry/exit access. Screening area is located immediately upon entrance. Auditory alarm sensors are present on all exits and require a code for access. Visitor Sign-in sheet, hand sanitizer, gloves and masks are available. Covid 19 prevention protocols are posted. Hand washing, coughing etiquette, and other necessary signage are posted in the bathrooms, hallway, and throughout the facility. Room temperature is comfortable; wall thermostat displays a setting of 76.0°F . within the required range. An approved Mitigation and Infection Control plan is on file. Required postings are prominently displayed and observed to be current. Disaster drills were last conducted on 3/15/2024. [LIC809C Continued] Fire Detection/Protection system is present in the facility. Multiple dual-carbon monoxide detector/smoke alarms are installed, hardwired, and interconnected. Fire alarms were tested and function properly. LPA observed One (1) fire extinguisher located in the kitchen area, and one extinguisher located in the main hallway. Both extinguishers show service date: 02/12/2024. Kitchen: At 10:05AM , LPA observed kitchen as clean, equipped with a functional stove, multiple appliances, with adequate supply of perishables and non-perishable food. Open pantry space stores emergency dry food, condiments, and can goods. Food observed as properly labeled and stored. Kitchen cabinets store dishes, plastic, paper goods and utensils. Knives and sharps are secured in a locked drawer and inaccessible to residents. Medications are stored in a secured medications cart in dining room area and are inaccessible to residents. Medications are listed on a centrally stored medication and destruction record log. A First Aid kit is complete and stored in the medication cabinet. Laundry area is located and secured in hallway storage compartment near the kitchen. Laundry soaps and other cleaning agents are stored and inaccessible to residents. Storage observed to have adequate supply of linen and towels. Commons: LPA observed all common areas of the facility, including the living room and dining areas, adjacent to the kitchen, to be clean and organized. Furnishings are in good condition. Bedrooms are observed as clean with sufficient lighting, properly furnished with bedding, dressers, closets, linens, at least one chair, and night stand. Bathrooms were observed to be clean and sanitary, with necessary supplies and required safety features. (grab bars, anti-slip floor stripping) Hot water temperature measured at 114.8°F. Within the required range. [LIC809C Continued] Outdoor (backyard) area observed to have a shaded patio, with table with sufficient seating for the residents. Outdoor furniture observed to be in good condition. All trash cans were observed to be covered. There are no bodies of water in the facility. Resident records: At 12:35 PM, Resident files were reviewed for current IPP and/or Needs and Services plans, physician report, and admission agreements. Resident records appeared to be complete and current. Staff records: Staff files were reviewed. Criminal record clearances, Health Screening, Employee Rights Records were present and Staff are associated to this facility. Staff records appear to be complete and current. There were no immediate health and safety hazards observed at the time of this inspection. Exit interview conducted and a copy of this report was given to facility representative, Administrator Brain Rosales.