Routine inspection·October 12, 2024

On 10/12/24, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Staff Robert Lim. LPA spoke with the Administrator Ma Salvacion Medina over the phone. The facility is licensed to serve six (6) ambulatory residents, all of which four (4) may be non-ambulatory and one (1) may be bedridden. Bedroom #1 is approved for ambulatory. Bedroom #2 and #4 are approved for non-ambulatory. Bedroom #3 is approved for bedridden and non-ambulatory. The facility has a hospice waiver approved for six (6) residents. The facility is a single-story structure located in a residential neighborhood. It has a ramp that goes along the west side of the facility. It consists of (4) bedrooms, (2) full bathrooms, shaded back yard, front yard, laundry room and a attached garage. Staff accompanied LPA inside and outside the facility during this inspection. 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, shower was free of mold/mildew, and a non-skid mat was in place. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Continue to LIC809-C. 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 in locked storage cabinet. Staff tested the carbon monoxide detector and smoke detectors in the house. Both devices were functional. Three (3) staff records were reviewed. Four resident records were reviewed and two residents’ medication was reviewed. Deficiencies were observed during today’s visit but due to insufficient time, an annual continuation is required. An exit interview was conducted and a copy of this report was discussed with the Administrator over the phone and left with Staff Robert Lim .