Routine inspection·December 5, 2024

On December 5, 2024, Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced required annual visit using the CARE Inspection Tools. LPAs met with staff Alvin Geniza and explained the purpose of this visit. Rodrigo Rosaldo subsequently arrived to assist with visit. The facility is license to serve (6) elderly residents ages 59 and older. The fire clearance is approved for (5) non-ambulatory and (1) bedridden resident in room #4. Approved Hospice waiver for (6). Currently there are 4 residents over the age of 60. Structure The facility is a single-story structure located in a residential neighborhood. It consists of the following: (5) residents' rooms, (2) bathrooms, (1) staff room (1) staff bathroom, a living area, a dining area, a kitchen, an outside seating area and a garage Back Yard, Ramps and Outside table with shade. Physical Plant LPA and Staff Alvin Geniza toured the facility inside and outside. LPA observed 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. Bed linens, comforters, and bath towels were available. Bathrooms were operational with water temperature measured at 111.2 F. A comfortable temperature of 75 degrees F. was maintained in the facility. Page 1 of 3 Bedrooms LPA inspected all (5) bedrooms. All bedrooms were observed to have the required furniture including beds, dressers, night stands 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. The water temperature measured 111.2-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. Kitchen/Laundry Room LPA inspected the kitchen and observed all appliances to be in good working repair, including stove/oven, microwave, dishwasher, washer, dryer, refrigerator, LPA observed an ample supply of 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. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods. Washer and dryer located back hall of the facility. page 2 of 3 Common Rooms In the living room, LPA observed, ample seating for all residents. In the dining room, LPA observed a rectangle table and chairs to accommodate all residents. The facility is maintained at a comfortable temperature. Safety LPA observed and tested smoke/carbon monoxide detectors to be fully operable. LPA observed an addition Carbon Monoxide detector in the hallway. LPA observed 2 fully charged fire extinguisher mounted on the wall, last serviced on 6/29/24. LPA inspected the First Aid kit and found it contained an ample supply of required items. LPA observed the required posting in the facility. LPA observed all exits to be clear and easily accessible. There are no firearms or ammunition stored on the premises. Medications LPA observed all centrally stored medications in their original packaging and are secured in a locked cabinet near kitchen area. Files /postings LPA reviewed four (4) resident files and found that 4 out of 4 contained all the necessary documentation. LPA reviewed four (4) staff files and found that 2 out of 4 contained the required documentation, certification, and training. LPA observed all required posting. Infection Control During the visit, LPA observed the facility’s infection control practices. There were 2 deficiencies issued during this visit. Deficiencies are documented on the 809D. Exit interview conducted with Administrator Rodrigo Rosaldo and copy of report and appeals right provide. page 3 of 3