Routine inspection·July 17, 2025

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with staff#1 (S1) and explained the reason for the visit. At approximately 9:50 am, with the assistance of staff, LPA took a tour of the physical plant to ensure the health and safety of the residents are protected and that the physical plant complies with Title 22 Regulations. Required postings were observed in the entry area. The facility is a two-story building. From the first floor, there is a stairwell that leads to the 2nd floor. The stairwell has a door that is being kept locked. On the 2nd floor, there are two bedrooms, each has a bathroom and two balconies. The 2nd floor is furnished. Staff#1 (S1) stated that the 2nd floor is being used by other staff members. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility, properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. The fire extinguisher is located in the kitchen with a purchase date of March 9, 2025. Bedrooms: There were four (4) bedrooms designated for residents' use. Three (3) bedrooms are designated for private use, and one (1) room is shared. All four bedrooms, in use by residents, were properly furnished with appropriate bedding and linens, with sufficient lighting. Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 106.8 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. The dining room table is large enough to seat the capacity of the facility. Seating such as couches where in good repair and sat the capacity of the facility. (Continue on 809 C) Surrounding Grounds: Entry/exits were free of obstruction. There was a shaded area with furniture appropriate for outdoor use. The outdoor area was free of hazards. The side gate of the home was checked to ensure no locks were installed, and that the exit and passageway are clear for emergency evacuation. Laundry Area/ Garage: The laundry area is located in the garage, which is inaccessible to residents. The garage door is locked. The garage is used only for storage. LPA observed storage boxes and an extra fridge with additional food supplies. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and in compliance with licensing forms. Resident Files: LPA conducted a file review of resident records to ensure compliance with licensing forms. LPA observed that per the Physician Report, Resident#3 (R3) is bedridden. R3 resides in Room#1, which is not cleared for a bedridden resident. LPA reviewed the facility's fire clearance and noted that the facility is approved for 1 resident in Room#4. The facility currently has 2 bedridden residents. Resident 1 is in Room#4, and Resident 3 is in Room #1. LPA advised the Administrator regarding the fire clearance violations. The administrator stated that she will obtain approval for fire clearance for R3 residing in Room#1. Medications: Medications and Medication Records were inconsistent. The administrator was advised to conduct medication audit and provide complete medication records. Exit interview conducted, immediate civil penalty and other citation issued. Copy of this report is delivered.