Routine inspection·September 19, 2023

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection. LPA arrived unannounced and met with Co-Administrator, Emelita Alangui, who assisted with the visit. The facility is licensed for 6 non-ambulatory residents, ages 60 and over, and there is an approved hospice waiver. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Facility staff are using appropriate hand hygiene and wearing gloves while assisting residents with some of the activities of daily living. Facility has sufficient PPE supplies. Licensee has submitted an Infection Control Plan. Operational Requirements: The facility has a dementia care plan to accept or retain residents with dementia. There are currently 6 residents residing at the facility. The facility has maintained the sufficient amount for liability insurance covering injury to residents and guests. Physical Plant & Environment Safety: The facility has 4 resident bedrooms, 1 staff room, 2 bathrooms, living room, dining/family room, kitchen, and attached garage. There is no swimming pool on the premises. Facility has operable smoke and carbon monoxide combo detectors. Knives, cleaning solutions, and disinfectants are locked. There are no firearms or weapons stored at the facility. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. Food Service: There are sufficient food supplies of 2-day perishable and a week of non-perishable items. The foods are properly stored in the refrigerator. The kitchen is kept clean and free of insects. There are no deficiencies issued today. LPA will return another day to complete the rest of the inspection. An exit interview was held and a copy of this report was given to Emelita Alangui.