Routine inspection·November 21, 2024

Licensing Program Analyst (LPA) Lorena Casillas met with administrator Aldrin Perez for an unannounced one (1) year Required visit for this facility. LPA arrived at 09:20 am and was greeted and granted access by Administrator. There are five (5) residents in the facility. Three (3) residents are bedridden, two (2) of which is in hospice care. Two (2) residents are ambulatory. LPA observed all residents to be in their rooms watching TV or sleeping. Infection control: The facility has an Infection Control Plan approved on 03/30/2021. Proper signage was observed inside along the hallway and in the restrooms. Kitchen: LPA observed the kitchen to be clean and clear of clutter. All appliances were operative. Cleaning solutions are locked under the sink. Knives are kept locked in a kitchen cabinet inaccessible to residents. LPA observed smoke alarms throughout the facility that are interconnected. At 11:30 a.m. all smoke alarms were tested and functioned properly. LPA observed one carbon monoxide detector and it appeared to be functioning. Dining / Living Area: The dining and living area were well lit, clean, and clear of clutter. Furniture appeared clean and in good repair. A fireplace located in the living area is covered and not in use. LPA observed the thermostat at a comfortable temperature of 75°F. There is a fully charged fire extinguisher located near the main entrance that was last purchased on 11/21/2024. Continued on LIC809-C Bedrooms: There are five (5) bedrooms designated for resident use. One (1) out of the five (5) rooms is shared. All resident rooms are furnished with required lighting, dresser, chair, bed, and linens. Bathrooms : There are two (2) bathrooms designated for resident use. One (1) bathroom is located in the shared bedroom and the other main bathroom is accessible to all the residents. Both bathrooms were well lit and clean, had grab bars, had hand washing signs, nonskid mats, and trash bins with lids. LPA observed a sufficient supply of hand soap and paper towels. Water temperature in the main bathroom was measured at 118.5 degrees Fahrenheit. Laundry Room: LPA observed the laundry room to be locked and inaccessible to residents. Garage: LPA observed garage to be used for extra storage. There is a freezer stocked with appropriately labeled food. There is an additional supply of canned goods. Surrounding Grounds : There were no visible hazards, and passageways were free from obstruction. Side gates on either side of the house were closed but unlocked. There is a covered patio to provide shade and appropriate outdoor seating for residents. LPA observed two sheds in the backyard, one (1) for storage and another one being used as an office. Administrative: Annual fee is not current. LPA provided Administrator with PIN and payment was made during LPA visit. Administrator provided LPA with confirmation # 950982. LIC 500, Liability Insurance and Resident roster were collected. Staff Files : LPA conducted a file review of staff records at 1:05 pm. Resident Files : LPA conducted a file review of resident records to ensure compliance of licensing forms at 1:30 pm. Medications : At 2:30 pm LPA and Administrator reviewed medication and medication records. Staff/Resident Interviews : At 2:50 pm LPA interviewed staff. Exit interview conducted and a copy of this report issued.