Routine inspection·May 20, 2025

On 05/20/25, 10:35 AM, Licensing Program Analyst (LPA) Raymond Comer conducted an unannounced annual visit at this facility. LPA met with Facility Administrator, Alexcis Peralta , and reason for the visit was disclosed. Facility is licensed as a single-story residence, fire clearance for twelve (12) non-ambulatory, of which, twelve (12) may be bedridden. Hospice waiver for twelve (12). Facility has six (6) shared resident bedrooms, and seven (7) bathrooms; one bathroom is available for use by both residents and staff. At the time of this inspection, one (1) resident is non-ambulatory; no bedridden. None of the facility's residents are receiving hospice care at this time. 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. Hand sanitizer, gloves, and masks are available. Hand washing, coughing etiquette, and other necessary signage are posted throughout the facility. Room temperature is comfortable; wall thermostat displayed a setting of 71.°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 3/29/2025. [LIC 809C-Continued] Fire Detection/Protection system Multiple smoke alarms and Carbon Monoxide sensors are installed throughout the facility; hardwired, and interconnected. Smoke and Carbon monoxide detectors were tested and function properly. LPA observed a fire extinguisher located in the kitchen area, with maintenance service date: 4/10/2025. Kitchen: At 11:15 AM, LPA observed kitchen as clean, equipped with functional stove, multiple appliances, with adequate supply of perishables and non-perishable food. Kitchen cabinets contain emergency dry food, can goods, condiments, dishes, plastic, paper goods and utensils. Food is observed as properly stored and refrigerated. Knives and sharps are secured and inaccessible to residents. Medications are stored in two (2) medications carts, located in a room adjacent to the dining area. Medications are listed on a centrally stored medication and destruction record log. A First Aid kit is complete and stored in the medication cart. However, upon inspection by LPA, one of the medication carts was found unlocked, which presents a potential for unauthorized access to residents and visitors. Laundry area is located in a separate building and and inaccessible to residents. Linen storage observed to have adequate supply of linen and towels. Commons: LPA observed all common areas of the facility, including the living room and resident dining area adjacent to the kitchen. LPA observed common areas to be clean, with adequate furnishings in good repair. Bedrooms At 12:00 PM, LPA observed bedrooms as clean with sufficient lighting, properly furnished with bedding, linens, at least one chair, and night stand. All bedrooms are equipped with a signaling system for Residents to request Staff assistance. Signaling system was tested; Staff responded to signal is less than three minutes. Bathrooms were observed to be clean and sanitary with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 116.5°F. Within the required range. Hand towels are not shared. [LIC809-C 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. Multiple sheds in the outdoor area contain tools, supplies, and PPE. All Sheds were observed as locked and inaccessible to Residents. All trash cans were covered. There are no bodies of water in the facility. Resident records: LPA observed records stored in a locked and secured records room, inaccessible to residents. 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: LPA observed records stored in a locked and secured records room, inaccessible to residents. Criminal record clearances 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 Alexcis Peralta.