Routine inspection·March 18, 2025

Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection on 3/18/25. LPA met with Staff, Maria Sanubari, and explained the purpose for the visit. The facility is licensed for (6) non-ambulatory residents, ages 60 and over, of which 1 may be bedridden. There is a hospice waiver approved for 3 residents. The facility consists of 4 resident bedrooms, 1 staff room with bathroom, one communal bathroom, a storage room, living room, dining room, kitchen, laundry room, and attached garage. There is an shaded area in the backyard with table and chairs. The facility is continuing to follow their Infection Control Plan. Staff are using gloves when assisting residents. The facility has a dementia care plan to accept or retain residents with dementia. There is one resident on hospice. The facility has the sufficient amount for liability insurance covering injury to residents and guests. Knives, cleaning solutions, and disinfectants are locked. The hot water temperature was measured between the required range of 105-120 degrees F. Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical/mental capability. There are sufficient food supplies of 2-day perishable and a week of non-perishable items. The foods are properly stored in the refrigerator. LPA reviewed 5 resident files and files are complete. The Local Ombudsman and Residents personal rights information are posted at the facility. LPA reviewed the administrator and 2 other staff files. The administrator's (Jacklyn Concepcion) certificate expires on 7/21/26. Staff employed are over the age of 18 and are fingerprint cleared. One of the staff did not have the TB test or First Aid completed. Staff are receiving on-going training. Medications are centrally stored in their original containers and they are given as prescribed by the physician. The facility has the updated Emergency Disaster Plan. Drills are being conducted however, LPA provided a technical advisory to ensure the documentation meets the criteria. Deficiencies are issued on the LIC809D. An exit interview was held with the Administrator. A copy of this report, LIC809D, and appeal rights were given.