Routine inspection·December 3, 2022

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Required 1- year visit using the Infection Control Evaluation Tool. LPA met with Caregiver Bennix Tuason and explained the reason for the visit. Administrator Lea Loaiza arrived shortly after. Physical plant was toured, medications records were reviewed, and food supply was reviewed. Facility is licensed to serve 5 non-ambulatory residents over 60 years old and may retain Hospice Waiver for 2 residents. LPA and Administrator Loaiza toured the facility. The facility is located on a residential corner street. The facility has an open front yard and enclosed backyard. The facility contains four (4) resident bedrooms, one (1) resident bathroom, one (1) staff room, one (1) staff bathroom, kitchen, living room, dining room and TV/visiting room, and laundry room. Auditory devices were observed on exit doors which are required for dementia residents and were operating at the time of the visit. LPA observed kitchen to be clean and sharps to be locked in near by cabinet. LPA observed sufficient food supply. Water temperature in kitchen was tested at 116.2F degrees which is within the required 105F – 120F degrees. LPA measured water temperature in resident bathroom at 112.6F degrees which is within the required 105 – 120 degrees F. LPA observed one of the two sinks located in resident bathroom to leaking water from hot faucet knob. Toilet was observed to have hairs, stains around the rim of the toilet bowl and toilet paper stuck around the rim of the toilet bowl. LPA observed the shower to have hair along the outside and inside of the shower. Shower floor was dirty, and LPA observed an insect walking around shower floor. Resident bathroom had the required grab bars in shower and near the toilet for non-ambulatory residents. Shower contained non-skid mat. All resident bedrooms contained a bed, linen, dresser, chair, light, and sufficient closet space. Cleaning supplies were observed to be locked in laundry room which is inaccessible to residents. LPA observed PPE supply in closet. Smoke detectors and were observed in each room and throughout the facility. Carbon monoxide and smoke detectors were tested and operable. Fire extinguishers were fully charged and inspected in October 2022. LPA observed animal feces throughout backyard area. Passageways and exits were free of obstruction. Deficenices were observed and documented on 809D. Exit interview was held with Administrator Loaiza and a copy of this report along with appeal rights were provided .