Routine inspection·September 4, 2025

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced annual inspection visit on 9/04/2025 and was greeted by Assistant Administrator Gloria Gibson. LPA Ramirez identified herself and explained the purpose of the visit. Administrator Brian Buenviaje arrived shortly after to assist. The facility is located on a residential street and is a single store dwelling. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected nine (9) resident rooms. Resident bedrooms#3 & 4 did not contain the required furniture. LPA Ramirez observed resident room# 3 and 4 were missing nightstand and chairs. Temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observed grab bars near toilets and near showers. LPA Ramirez observed non-slip coating in showers. LPA Ramirez observed seated shower chairs. LPA Ramirez observed several missing/broken vertical blinds in room#4,1, and 2. LPA Ramirez observed a shared bathroom in between room#5, to contain black fuzzy spots, spread across the ceilings, walls and corners. LPA Ramirez observed shared bathrooms and resident rooms 1,3,5,2, 4, and 9 to be malodorous and floors were observed to contain black and brown grime. During inspection, LPA Ramirez observed room#3, 4 and 5 signal system was not operational when tested. Administrator Brian Buenviaje arrived shortly after and reset the signal system. LPA Ramirez re-tested the signal system and observed the signal system to be operational. LPA Ramirez observed a cabinet with extra linen inside the "SSG" activities room. Interviews with staff revealed laundry is washed outside and folded outside and clean linen and towels are kept in this cabinet. During inspection and record review, LPA Ramirez did not observe resident room#6, 7 and 8. According to Administrator Buenviaje, resident room#7 was made into a spare activities room and storage area for laundry and linen. Resident room#6 was made into a mini kitchenette and food storage area. Resident room#8 was made into a staff office and medications storage. Review of facility sketch, and plan of operation did not accurately list rooms and usage. SEE 809-C for continued report. Food Service: LPA Ramirez observed a sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C). Planned Activities: LPA Ramirez observed board games, magazines, and other activities for residents. Residents Rights-Information: LPA Ramirez did not observe the following postings in common areas throughout the facility: Complaint Poster (PUB 475) and nondiscrimination notice. LPA Ramirez observed the facility land line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Last documented emergency drills were conducted on 08/22/2025 and 07/31/2025. LPA Ramirez observed an emergency food supply located in pantry. Residents with Special Needs : No large bodies of water were observed . Health Related Services/Incidental Medical Services: The medications are centrally stored in the medication closet and in bubble packs and/or original containers. LPA Ramirez observed Centrally Stored Medication and Destruction Record. The facility provides incidental medical services. Infection Control: Staff are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. Operational Requirements: The fire clearance is approved for eighteen (18) residents over the age of 59 years old. All may be non-ambulatory. SEE 809-C for continued narrative. Resident Records/Incident Reports: LPA reviewed resident records for six (6) residents in care. Resident records are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, and Resident Rights were observed. LPA Ramirez observed two (2) out of six (6) reappraisals were not updated once every 12 months or as necessary, even after residents had significant updates on their medical assessments. Due to time constraints, LPA Ramirez will return to complete annual inspection. Seven (7) violations were cited and one (1) Technical Advisory was issued. Exit interview was conducted. A copy of this report was provided via email.