Routine inspection·July 17, 2025

On Thursday, 07/17/25, 9:45 am, Licensing Program Analyst, (LPA) Raymond Comer, arrived to conduct an unannounced annual inspection visit. LPA met with Administrator Jocelyn Espiritu, and reason for the visit was discussed. Facility is licensed as a single-story residence. Total capacity for six (6) non-ambulatory; one may be bedridden. Hospice waiver for four (4). Facility has four (4) total resident bedrooms; two private, and two shared. Facility has two (2) bathrooms. At 10:00 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. Visitor Sign-in sheet, 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 displays a setting of 76.0°F., within the required range. Rear glass doors allow exiting to back yard. The facility maintains a Mitigation and Infection Control plan. Required postings are prominently displayed and observed to be current. Disaster drills were last conducted on 7/01/2025. [LIC 809C]-Continued KITCHEN area is clean and clear of clutter. LPA observed refrigerator, microwave, stove/oven, dishwasher and sink to be operational. Knives/Sharps are stored in lower cabinets, locked and inaccessible to residents. Plates, cups, utensils, and two day supply of perishable food is properly stored and labeled. A seven day supply of nonperishable food is located in kitchen area pantry . Dish Soap, cleaning solutions, and toxins are stored in locked lower cabinet underneath the kitchen sink. FIRE DETECTION/SUPPRESSION SYSTEM present at facility. Multiple combination smoke\ carbon monoxide alarm detectors are installed, hardwired and interconnected. Smoke and Carbon monoxide detectors were tested and function properly. Two (2) fire extinguishers were observed; located near the front entrance and rear exit. Extinguishers indicate a full charge; last inspection service date: 03/11/2025. BEDROOMS : Resident bedrooms #2 and #3 are private. Resident bedrooms #1 and #4 are shared. All bedrooms are observed as clean with sufficient lighting, properly furnished with bedding, linens, at least one chair, and night stand. 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 117°F. Within the required range. OUTDOORS: (backyard) area observed to have a shaded patio, with tables with sufficient seating for the residents. Patio furniture was observed to be in good condition. All trash cans were observed to be covered. There are no bodies of water in the facility. COMMON AREAS: Entry and exit doors have a functional auditory alert when the doors open. Dining room is furnished with table large enough to accommodate residents, staff, and visitors. Dining room furnishing with sitting area, television, stored games, reading materials. Furniture and fixtures are clean and in good condition. Facility telephone was operational at time of visit. RESIDENT RECORDS are stored in secure and locked file cabinet in kitchen area and inaccessible to residents. Records were reviewed for current IPP and/or Needs and Services plans, physician report, and admission agreements. Resident records appear to be complete and current. [LIC 809C]-Continued STAFF RECORDS are stored in secure and locked file cabinet in kitchen area and are inaccessible to residents. Records were checked for criminal record clearances\associations to this facility. Staff records appear to be complete and current. MEDICATIONS: are stored in locked and secured medications cart located in the kitchen area; inaccessible to residents. Medications are listed on a centrally stored medication and destruction record log. A First Aid kit is complete. No immediate health and safety hazards observed during today's inspection. Exit interview conducted and a copy of this report was given.