Routine inspection·February 9, 2024

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required 1-year Visit on 02/00/2024. LPA was met by Caregiver Baltazar Reyes and explained the purpose of the visit. The facility is licensed to serve six (6six (6) residents over the age of 60, of which six (6) may be non-ambulatory and has a hospice waiver approved for two (2). LPA OBSERVATIONS: The facility is a single-story dwelling located on a main street and consists of four (4) resident bedrooms, one (1) staff bedroom, two (2) shared bathrooms, kitchen, dining room, living room, attached garage, front yard, and backyard. LPA Ramirez observed auditory device on entry of door to be operational, sliding door and exits. Front Yard: Front yard is well maintained, and no hazards were observed. Kitchen: LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed centrally stored medications in kitchen cabinet to be locked during visit. LPA Ramirez observed sharps and knives near kitchen cabinet to be locked during visit. First aid kit was observed in kitchen cabinet. Emergency food supply was stored in kitchen pantry. Dining Room/Living room/: LPA Ramirez observed plenty of lighting and seating in this area. LPA Ramirez observed several recliners in living room area. One (1) large dining room table with six (6) chairs was observed. Laundry room: LPA Ramirez observed laundry detergent to be locked during visit. Linen Closet: Contained plenty linens, towels, and hygiene products. Resident Rooms 1-4: LPA Ramirez inspected four (4) resident rooms. LPA Ramirez observed all rooms to contain required lighting, furniture, and linen. LPA Ramirez observed auditory device on S6’s bedroom door. Bathrooms 1-2: bathroom# 1 water temperature measured at 106.2-degree F which is within the required 105F - 120F degrees. LPA Ramirez observed Resident bathroom #2 water temperature was measured at 105.6-degree F which is within the required 105F- 120F. LPA Ramirez observed signs promoting proper hand washing. LPA Ramirez observed grab bars near toilet and showers and no slip coating in showers. Backyard: No hazards were observed. Plenty of shade and seating was observed. Garage: LPA Ramirez observed emergency water in this area. Emergency Drills: Last documented fire drill wasdrills were conducted on 01/16/2024 and 02/13/2023. Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher & Emergency Disaster Plan: LPA observed carbon monoxide in hallways and smoke detectors were observed to be operable. Personnel Records: Personnel records are maintained at the facility. LPA Ramirez reviewed three (3) personnel records. Documented proof of required annual initial training and annual training was observed. Administrator's Certificate for Lea Loaiza was observed with an expiration date of 9/19/2024. Resident Files: Six (6) resident files and Medications Administration Record (MAR) were reviewed. Liability Insurance & Infection Control Plan: Licensee could not provide liability insurance. LPA Ramirez observed infection control plan however, infection control plan was not observed to comply with Title 22. Deficiencies are being cited. Deficiencies and technical advisories are being cited. A copy of this report, 809-D, and appeals rights were provided to Lea Loaiza.