Routine inspection·July 21, 2022

Licensing Program Analyst(s) (LPA) Mary Flores and Ashley Calderon conducted an unannounced annual visit with focus on infection control, medication, and food review. LPAs met with and conducted a tour of the facility. The facility is licensed to serve 40 non-ambulatory residents ages 60 and over with an approved hospice waiver for 5 residents. The facility is a 2 story building located in a residential area, it has 20 shared rooms, and shaded sitting area. Facility does not have a kitchen and per the plan of operation they receive food prepared in their sister facility for all resident meals. LPAs conducted a tour of the facility with Rosalie Sandoval administrator and observed the following: A dining area, a common activity/ television room was observed, have sitting area to allow for social distancing. Signs and posters were observed upon entering the facility, common areas and the medication room. Medications are kept in the medication room and were locked. LPAs observed cleaning supplies and PPE supplies that were observed locked in storage cabinets. No sharp items were observed. The following rooms were observed, rooms #70,72,81 and 86, each room had sufficient lighting, bedding supplies, and furniture. Each room had their own bathroom with a sink,bathtub observed having a skid mat and grab bars and proper working toilet. Room #70 water temperature tested at 114.4 degrees F, Room#72 was tested at 112.4 degrees F, room #81 tested at 114.4 degrees F., and room #86 tested at 112.8, which is within the required 105 - 120 degrees F. Medication and files were reviewed for 3 residents and 4 staff files. Administrator certificate was observed # 6012456740 expiration date 1/24/24. Facility is maintaining Infection control recommendations per guidelines and recommendations. Exit interview was conducted with Rosalie Sandoval Administrator and a copy of this report was provided.