Routine inspection·October 8, 2025

On 10/08/2025 at 11:00am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one (1) year annual inspection. LPA met with Ivonne Meader (Administrator) and Elsa Roman (Assistant Administrator) the purpose of the visit was discussed. Facility is licensed to serve 6 non-ambulatory residents and an approved for six (6) hospice waivers. The six (6) of the residents are diagnosed with dementia, one (1) hospice, zero (0) home health resident and zero (0) bedridden resident. The facility has a current administrator certificate (#7033600740) for Ivonne Meader valid from 08/20/2024 -08/19/2026 .The facility fees are a at $0 (paid on 10/06/2025 ; confirmation # 983254).The facility has liability insurance with Sunland Risk Retention Group with each occurrence at $1,000,000 and general aggregate at $3,000,000 (policy #SRRG2025-191) effective date 08/15/2025 - 08/15/2026. The disaster drill was conducted on 10/03/2025 (for power outage). The facility is a two (2) story home consisting of: (6) resident bedrooms, (2) full bathroom, (2) resident toilet rooms, (1) living/entry room, (1) dining room/tv/activity room, (1) kitchen, (1) detached garage with extra refrigerator, (1) laundry room, and (2) hallway closets. The second floor consist of (1) staff bedroom, (2) staff bathrooms and (1) office room. The outside of the facility provides an (3) outdoor shaded area with a front and backyard. Report continues on LIC 809-C Between the hours of 11:29pm - 1:00pm, LPA conducted a records review of (6) client records, (6) staff records, and reviewed the facility disaster plan. All client & staff records were complete. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (6) Client Medication Administrations Records and did not observed any discrepancies at the time of visit. Between the hours 1:24pm -1:41pm, LPA toured the facility with Elsa Roman (Assistant Administrator) and observed resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured at 112.1°F in bathroom #1 ,114.8 °F in bathroom #2, 109.4°F in half-bathroom #1, 113.4°F in half bathroom #2: & Kitchen: 113.5 °F . Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. During todays visit LPA did not observe any deficiencies. Exit interview conducted with Ivonne Meader (Administrator) and Elsa Roman (Assistant Administrator).