Routine inspection·October 14, 2025

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced Required - 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to the Administrator Jared Green and Maria Roleda, Wellness Director, assisted LPA with the visit. On today's date, LPA inspected the following domains 1.Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. Facility still practices the infection control with hand washing. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. 2. Operational Requirements : The current plan of operation is completed. The facility has a Dementia Waiver in place. A Hospice Waiver for 20 residents is approved. A fire clearance for 85 non-ambulatory residents, of which 9 may be bedridden, is in place. Liability Insurance in the amount of at least ($1,000,000) per occurrence and total amount of aggregate ($3,000,000) is in place. 3. Physical Plant/Environmental Safety: The facility consists of a 5-floor building. The first through fourth floors consist of residents rooms and the fifth floor is the dining area. The common areas are located on the first and third floors. LPA inspected random rooms and are clean and have required furnishing. Bathrooms were clean, toilets and water faucets worked properly and were properly supplied, have functional fixtures, and have secure grab bars. Emergency pull cords were observed in every resident room. (See LIC 809C for continuation) (continued from 809) Showers were free of mold/ mildew and non-skid mats or strips were properly in place. The hot water temperature was tested between 109.4 and 115.8 F which is within the Title 22 regulation of 105.0 – 120.0 degrees F. LPA also inspected the carbon monoxide detectors in the facility, are working properly. The facility has a telephone service on the premises. 4. Staffing: The facility has sufficient staffing to provide care and supervision to residents. 5. Personnel Record-Training: All the staff are over 18 years old and they are fingerprint clear and associated with the facility. LPA inspected four (4) staff files, and they all have the required documents which include heath screening, TB test result, required training hours, updated first aid and CPR certificate. The facility administrator is Jared Green and his administrator certificate expiration date in 4/14/26. 6. Resident Record-Incident Reports: LPA inspected four (4) residents files and they all have the required documents in file which included: admission agreements, Physician's Reports, Appraisal, TB clearance, Functional Capability Assessment, Physician's Orders, medical consent, and medication records. 7. Resident's Right : LPA observed the required posters posted on the board on the first floor in the TV/Living room which include Long Term Care Ombudsman, Community Care Licensing Complaint and Personal Right Poster. The residents also have internet service for at least one internet access device for residents to communicate with their family members or physician. 8. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. An activity calendar is posted, and LPA reviewed the calendar for the facility. 9. Food Service: The facility has sufficient 2 days perishable and 7 days non-perishable food supply and the emergency food supply are stored and locked in emergency food supply room. 10. Incidental Medical and Dental: LPA inspected four (4) residents medication, and the medication is centrally stored and locked in the Wellness Center room, and they are accurate and updated and also contain 30 days’ supply of medication. The facility will also provide transportation to residents' medical and dental appointments. 11. Disaster Preparedness: The facility has an Emergency Disaster Plan (LIC610E) posted but needs updated to show one evacuation site out of the area. The last fire drill was conducted on 09/16/2025 and the last disaster drill was conducted on 06/06/2025. Records of resident Appraisal and Needs services plans are part of Emergency training. 12. Residents with Special Health Needs: No residents in the facility with prohibited health condition. Currently there are three (3) residents on hospice and two residents in home health. Individual Service Plan and appraisals are on resident's files for home health and hospice. No deficiencies were observed during the visit. Technical advisories provided. Exit Interview Conducted and a copy of the report was provided to Wellness Director Maria Roleda