Routine inspection·February 20, 2025

On 2/20/2025 at approximately 10:00 AM, Licensing Program Analysts (LPAs), Angelica Segovia and Leslie Ngo-Castaneda conducted an unannounced annual visit to the facility. LPAs were greeted by Administrator Chrysel Dela Cruz. LPAs stated the reason for their visit. LPAs asked for census, Staff/Resident Roster, and Insurance. LPAs conducted a physical plant tour at approximately 11:00 AM and the following was noted: There is only one entrance being utilized at the facility. The facility is a single unit building with four (4) bedrooms and two (2) bathrooms currently occupying three (3) residents. There is one (1) designated staff room. The facility has approved fire clearance for six (6) non-ambulatory residents. Hospice waiver approved for three (3). Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. Required postings such as See/Say Something, Facility Sketch, and Facility License are located immediately upon entrance. Common areas: Living room and dining room observed to be neat, clean, and organized. Both rooms observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 73°F. Fire extinguishe r located in the kitchen and dated 04/24/24. Fireplace: Observed to be covered and inaccessible to residents. Working telephone observed. Kitchen: Kitchen observed to be clean and inaccessible to pests. Sufficient supplies of seven (7) day nonperishable food and two (2) day perishable foods were observed. Knives and sharps observed to be locked in kitchen drawer. Toxins and cleaning solutions locked underneath kitchen sink. Kitchen appliances observed to be working and in proper condition. (continued on LIC 809-C) Bedrooms: The Residents' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. Extra linens/covers stored in storage closet located in hallway’s passageway. Bathrooms : Bathrooms were checked for cleanliness and proper operation. Appropriate grab rails and skid mats were observed and in proper condition. The hot water temperature was measured within regulations at 114.3°F. Laundry Room: The laundry room is located near the bedrooms and kept locked. Laundry appliances observed to be working and in proper condition. Additional cleaning solutions, toxins, and laundry detergent stored in locked storage cabinet in hallway leading towards laundry room. Garage: The garage can be accessed from inside the facility and is kept locked. Extra refrigerator and freezer stocked with additional food for residents Backyard: The backyard of the facility is equipped with a designated shaded area with outdoor furniture for residents. There is no body of water in this facility. Medications: Medication logs and facility files kept stored in locked cabinet in the kitchen. First-aid kit observed to be equipped with but not limited to bandages, scissors, digital thermometer, tweezer, and manual. Smoke detectors and carbon monoxide observed to be working properly and were tested. Last Fire Drill conducted on 1/22/25. Resident/Staff Records: LPAs conducted a complete file review of resident records. Resident records appeared to be complete and updated. Staff records: LPAs conducted a complete file review of staff records. Staff records appeared to be complete and updated. Citation issued. See LIC 809D. There were no other immediate health and safety hazard observed during the day of inspection. Exit interview conducted, Appeal Rights given, and a copy of this report was provided to the Administrator.