Routine inspection·February 6, 2025

On February 6, 2025, Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced required annual visit using the CARE Inspection Tools. LPAs met with Administrator Maria Tavarez and explained the purpose of this visit. The facility is licensed to operate for six (6) non-ambulatory residents ages 60 and over and has an approved hospice waiver for two (2) residents. The facility is a single story, 5 bedrooms which 3 bathrooms are for residents and 1 bedroom is for live-in staff, 2 common restrooms, 1 private restroom, one (1) laundry room, dining area, living room with staff computer, kitchen, pantry, linen closet, a designated outdoor shaded area and a detached garage that stores a freezer and additional food, paper and hygiene products. Physical Plant LPA and Administrator Maria Tavarez 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. LPA observed that facility had required postings: Facility license, personal rights, ombudsman information poster, facility sketch, exit signs, infectious disease postings, Administrator certificates, an emergency disaster plan . Page 1 of 2 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. Resident’s toiletries and incontinent supplies observed in resident rooms. The water temperature measured 105.4 degrees Fahrenheit. All 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 hall closet. . Kitchen LPA inspected the kitchen and observed all appliances to be in good working repair, including stove/oven, microwave, dishwasher, refrigerator. LPA observed an ample supply of cutlery, pots, pans, and bowls to be in good repair. LPA observed knives and additional sharps to be secured in locked cabinet under the sink and are inaccessible to residents. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods. There is a laundry room where the washer and dryer are located. The detergent and other cleaning supplies are locked in a cabinet inaccessible to residents in care. Due to time restraint, LPA to complete inspection on subsequent visit. There were no deficiencies cited during this visit. Exit interviewed conducted and copy of report provided to Administrator Maria Tavarez. Page 2 of 2