Routine inspection·April 29, 2024

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 04/29/2024. LPA was met by Caregiver Valentino Delgado and explained the purpose of the visit. Administrator Michelle Aguirre arrived shortly after to assist with the visit. Facility is licensed to residents 60 years old and above. The facility is approved for two (2) ambulatory and four (4) non-ambulatory, of which one (1) may be bedridden. The facility may retain two (2) hospice residents. LPA requested and obtained a copy of Personnel Report (LIC 500), Resident Roster (LIC 9020), copy of liability insurance and updated Infection Control plan. LPA OBSERVATIONS: The facility is a single-story building with five (5) resident bedrooms, one (1) staff bedroom, two (2) resident bathrooms, one (1) staff bathroom, kitchen, dining room, living room, den/tv room, utility/laundry room, front yard, backyard. Front Yard: Was clean and well maintained. No hazards were observed. Kitchen: LPA observed kitchen to be clean and appliances appeared to be in working order. LPA observed sufficient 2 days of perishables and 7-day supply on non-perishables. Dining Room/Living room/Den/TV room: Dining room was observed to be clean and contained table and 4 chairs. Living room area has plenty of seating for residents and guests. Den/Tv room was observed to be clean and contained plenty of seating. LPA Ramirez three (3) residents sitting in this area during inspection. Linen Closet: Contained plenty linens, towels, and hygiene products. Resident Rooms 1 - 3: All but one resident bedroom is shared. All contained the required furnishings, linens and were observed to be clean. See 809-C Centrally Stored Medications: Was observed to inaccessible to four (4) out of four (4) residents in care. Medications are stored in facility medications cabinet, which is in facility utility room/laundry room. Emergency Drills/Emergency Disaster Plan/First Aid Kit: LPA Ramirez observed Emergency & Disaster Plan (LIC 610E) during inspection. LPA Ramirez observed a First Aid kit in facility utility room. Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher: LPA observed carbon monoxide in hallways and smoke detectors were observed to be operable. Personnel Records: Personnel records are maintained at facility. LPA Ramirez reviewed staff files for three (3) staff. LPA Ramirez observed Administrator’s certificate for Lea Loaiza with an expiration date of 09/19/2024. First Aid & CPR Certificate, Fingerprint Clearance/ Exemptions, Personnel Record/Job Application, Health Screening, Employee Rights, TB Test, and Initial/Annual Training Verification were observed for two (2) out of three (3) personnel records observed. Resident Records: Four (4) resident files were reviewed. Admissions Agreement, Medical Assessment, Consent Forms, Appraisal and Needs and Services plan, I.D and Emergency Information, TB Test, Centrally Stored Medication Record, and Personal Rights Form were observed. Liability Insurance & Infection Control Plan: Facility has current liability insurance on file. LPA Ramirez observed updated infection control plan. No deficiencies were cited during this inspection. Exit interview was conducted and a copy if this report was provided via email due to printer issues.