Routine inspection·November 16, 2021

Licensing Program Analyst (LPA) Shira Stamps met with designee, Mayen Agcaoili, for an unannounced one (1) year Required visit for this facility. The facility has not admitted any residence since it has been opened. Infection control: LPA Stamps reviewed facility mitigation plan (approved on 06/04/21) to make sure the licensee was following the current infection control recommendations. Upon arrival the team was screened by the licensee and asked all infection control questions. LPA were asked to sign-in and sanitize/wash hands. LPA arrived at 9:45am and contacted the Licensee; who stated the designee was at the facility. LPA was greeted by designee, Mayen Agcaoili . LPA informed the designee of the purpose of the visit. A tour of the physical plant was conducted with the designee at 10:00am. The facility has four (4) bedrooms and two (2) bathrooms. The facility is Fire Cleared for five(5) non ambulatory, one(1) bedridden. Resident Rooms LPA observed each room to have a night stand and sufficient lighting for each resident. LPA tested the exit doors auditory system and it was observed to be operational for each room. Bathrooms At 10:05am LPA observed all bathrooms to have non-skid matts, grab bars, and the appropriated wash your hands signs posted. Continued... Laundry Chemicals/hazardous items will be in a locked cabinet in the laundry area located in the garage. Food Inspection LPA conducted tour at the kitchen around 10:00am observed there to be sufficient stock of two day perishables and seven day non-perishables foods. Food storage and preparation areas care clean and inaccessible to pests. LPA observed all knives and sharp object being locked and inaccessible to future residents in care. Physical environment LPA toured the outside area of the facility at 10:10am. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. No bodies of water on the premises. Living and dining LPA observed the living room to be neat and clean along with the dining room. The facility maintains a comfortable temperature at 75°F. The smoke detectors were tested and observed to be operational at 11:00am. There is one(1) fire extinguisher, located in the kitchen. Fire extinguishers were observed to be full. License will provide LPA with service date appointment. Medication and staff files will be located in a locked hallway closet area.LPA observed the garage to be attached to the facility and currently being used for an extra food storage. Administrative: Annual fee is current. An exit interview was conducted and a copy of this report was emailed to the Licensee