Routine inspection·October 4, 2025

On 10/04/2025, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Staff Joel Morales. The facility is licensed to for (6) six non-ambulatory, of which (4) four can be bedridden. All rooms are approved for non-ambulatory and rooms #1, #2, and #3 are approved for bedridden. It has an approved hospice waiver for four (4) residents. The facility currently has one bedridden resident and it does not have any residents receiving hospice. The facility is a one-story house located in a residential neighborhood and consists of four (4) bedrooms, two (2) bathrooms, kitchen, living room/dining room, covered patio and a garage. The facility is clean. Staff accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure... Continue to LIC809-C. shower was free of mold/mildew, a non-skid mat was in place, and hot water temperature properly measured between 114.5 degrees F. Common areas were clean and clear of hazards and doorways were free of obstructions. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept locked. First Aid kit was available. Two fire extinguishers, last serviced April 2025, were observed in the dining room and near the restroom. Staff tested the carbon monoxide and smoke detectors in the house. Device is functional. Five (5) staff records were reviewed. Five (5) resident records were reviewed and two (2) residents’ medication was reviewed. Deficiencies are being cited according to Title 22, see LIC809-D. 1. During record review, Staff #5 (S5) was not associated to the facility. LPA Cloyd observed S5 working in the facility. S5 indicated that S5 has worked at the facility for about four days. 2. During record review, the facility did not have 20 hours of annual training hours for staff. LPA observed training records for January 2024. 3. During record review, Resident #1 - #3, and #5 did not have an annual assessment nor decline notice of an annual assessment on file. Continue to LIC809-C An exit interview was conducted, plans of correction developed, technical assistance provided, and a copy of this report with appeal rights was discussed and left with Staff Kevin Caponpon.