Routine inspection·August 20, 2025

On August 20, 2024, Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Licensee Rose Matute and explained the purpose of today’s visit. LPA was granted entry to this facility. The facility is licensed to operate for six (6) non-ambulatory elderly residents ages 60 and over. The facility has a hospice waiver approved for six (6). Structure This facility is a single-story residence located in a residential neighborhood. The home consists of five (5) bedrooms, four (4) bathrooms, kitchen, living room, laundry area and a dining room. The home has a detached garage and an outside shaded sitting area. Physical Plant LPA and Licensee toured the facility inside and outside. LPA observed that there were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the resident's personal belongings was observed. Page 1 of 4 Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational. A comfortable temperature of 75 degrees F. was maintained in the facility Bedrooms LPA inspected all 5 bedrooms. All bedrooms were observed to have the required furniture including beds, dressers, nightstands with lamps, chairs, and ample storage space for personal belongings. All bedrooms were observed to be clean, in good repair, and have ample lighting. Bathrooms LPA inspected the facility bathrooms. In the resident’s bathroom the toilet, faucets, and shower were fully operational. All safety handrails were securely fastened. LPA observed the showers to be clean and free of mold or mildew. The shower had a nonskid material in bottom and shower chair. Resident’s toiletries are secured in a cabinet under the sink. The water temperature measured 111.7-degrees Fahrenheit. The Staff bathroom was observed to be clean. The toilet and faucets are operational. Both bathrooms were observed to be clean, in good repair and within Title 22 regulations. Linens & Hygiene LPA observed all beds to have the required linens including mattress cover, fitted sheets, blanket, comforter, and pillow. LPA observed an ample supply of linens, towels, and blankets in the hall closets. LPA observed incontinence care products stored in the resident’s closets and in the hall closet. Kitchen LPA inspected the kitchen and observed all appliances to be in good working repair, including stove/oven, microwave, dishwasher, washer, dryer, refrigerator, and additional freezer. LPA observed an ample supply of cutleries, pots, pans, and bowls to be in good repair. LPA observed knives and additional sharps to be secured in locked drawers in the kitchen and are inaccessible to residents. Page 2 of 4 LPA observed a 2-day supply of perishable foods and a 7-day supply of nonperishable foods. All food was properly stored and labeled. Cleaning products and toxins were secured in a locked in a closet in the laundry room inaccessible to residents. Common Rooms In the living room, LPA observed, ample seating for all residents. In the dining room, LPA observed a 6 seated rectangle table and chairs to accommodate all residents. LPA observed all walkways and hallways to be clear, clean, and free of obstructions and hazards. LPA observed ample lighting is all rooms. The facility is maintained at a comfortable temperature. Safety LPA observed and tested smoke/carbon monoxide detectors to be fully operable. LPA observed 2 fully charged fire extinguisher mounted on the wall, last serviced on 11/6/24. The last emergency drill was conducted on 4/15/25. LPA inspected the First Aid kit and found it contained an ample supply of required items and a manual. LPA observed the required posting in the facility. LPA observed all exits to be clear and easily accessible. Medications LPA observed all centrally stored medications in their original packaging and are secured in a locked cabinet in the kitchen area. Page 3 of 4 Files LPA reviewed 5 resident files and found 5 out of 5 contained all the necessary documentation. LPA reviewed 3 staff files and found 3 out of 3 contained the required documentation, certification, and training. Liability Insurance, Liability Insurance expiration date 9/20/25. Infection Control During the visit, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance; visitors log with PPE supplies are readily available to staff, and an additional 30-day supply of PPE was observed. Sufficient paper towels, cleaning, and disinfecting supplies were observed. LPA observed required postings throughout the facility. LPA did not observe any deficiencies during the time of visit. An exit interview was conducted with Rose Matute, Licensee and a copy of this report was provided. Page 4 of 4