Routine inspection·May 12, 2025

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced annual inspection visit. LPA met with facility staff Laura Aguilar. The purpose of today's visit was discussed. The facility is licensed to serve six (6) non-ambulatory residents who are ages 60 and above and approved for three (6) Hospice Waivers. Facility had dementia program on file. Currently, two (2) residents are on hospice. Annual licensing fees are current. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: 1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. 2. Operational Requirement: Liability Insurance is updated and in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place. 2) PHYSICAL PLANT The facility is a one-story home with four (4) resident rooms, two (2) bathrooms, front porch, backyard, and attached garage. Resident rooms had the required furniture and in compliance. Bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. Hot water temperature was measured in a range from 112.6 to 113.1 degrees Fahrenheit. Adequate linen and personal hygiene supplies were observed. Medications were centrally stored, locked and inaccessible to residents in care. Auditory device alarms are operational. Smoke detectors and carbon monoxide detectors were tested and operable. Fire extinguishers were fully charged and replaced when needed. The outdoor area has a shaped area and seating. (continued on 809C) (Continued from 809) 4. Staffing: The facility has sufficient staffing, and the night supervision staff have current CPR/first aid certification. 5. Personnel Record-Training: All the staff files are maintained in the facility. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Some staff have required ongoing training. Administrator Luis Aguilar Certificate expires 09/23/2026 6. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Admission Agreements, Identification & Emergency Information, Pre-admission appraisal/Appraisal Needs & Services Plan. 7. Resident Rights-Information: The Complaint, ombudsman and CCLD poster are not posted. entry. Visiting hours are included in admission agreement. 8. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. 9. Food Service: The kitchen was inspected and did have sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be very clean and sanitary. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents. 10. Incidental Medical and Dental: Medication is centrally stored and locked in the medication cabinet near the kitchen. Four (4) centrally stored resident medications were reviewed, which contained 30-day supply of medications. All medications are administered according to physician’s orders, Disaster preparedness: The last fire drill was conducted on 04/28/25. The facility has an Emergency Disaster Plan posted at the facility. 12. Resident with Special Health Needs: 1 resident are receiving home health services. No resident is currently on postural support. Individual Service Plans and Appraisals are on file. No deficiencies observed during today’s visit. An exit interview was held. A copy of this report, and appeal rights were provided.