Routine inspection·July 27, 2023

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with staff#1 who assisted with the visit. The facility is licensed to serve six (6) non-ambulatory residents who are ages 60 and above and approved for four (4) Hospice Waiver. Facility had dementia program on file. Currently, two (2) residents on hospice. LPA discussed the purpose of today's visit with staff#1 and also administrator, staff#2, over the phone. During the visit, LPA conducted staff/resident interviews, used CARE inspection tool, and toured the facility. The facility is a single story home located in a residential neighborhood, consisted of three (3) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, a kitchen, a dining room, a living room with TV and a garage, and indoor/outdoor activity areas. Hot water temperature is measured at 119.5 degrees Fahrenheit which was within Title 22 Regulation guidelines. Smoke detectors and carbon monoxide detectors were operational. Due to insufficient time and information during the visit at this time, this annual visit needs further investigation. Exit conference was conducted and a copy of this report was provided to staff#2 .