Routine inspection·June 5, 2025

Licensing Program Analysts (LPAs) Elizabeth Irra and Blanca Gonzalez conducted an annual inspection visit. LPAs met with Shaunda Williams (Administrator) and discussed the purpose of today’s visit. This is a 2- story home which consist of (3) bedrooms, (2) bathrooms, living room, kitchen, dining area, office (upstairs) and an attached garage with the laundry unit. All resident bedrooms are located downstairs. This facility is approved for (6) non-ambulatory residents (3 of which may be under hospice). LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Facility has an Infection Control Policy in place. Operational Requirements: Facility is adhering to the operational requirements. Physical Plant & Environment Safety: LPA toured facility grounds. Fire smoke alarms and carbon monoxide detector observed and tested. The fire extinguisher observed and appeared to be full (located near the kitchen area). Last drill was conducted on 05/01/25. Bedrooms have the required furniture. Supply of food (perishable and non-perishable) observed. Bathrooms have non-skid surfaces and grab bars. Hot water temperature (hallway bathroom) measured at 130.4*. Deficiency cited. Refer to LIC 809C for the continuation of this report. Staffing : Facility is adhering to staffing requirements. Personnel Records-Training : Staff files are maintained at the facility. LPA reviewed staff files for S-1 through S-4. Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis Screening on file. Resident Rights-Information: Resident rights are posted and are included in Resident files. Planned Activities: Activity provides planned activities. This facility also provides internet access to the clients. Food Service: There are sufficient food supplies of 2-day perishable and (1) week of non-perishable items. The food is properly stored in the refrigerator. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept cleaned and stored properly. Dining areas have adequate seating. Resident Records-Incident Reports: LPA reviewed Resident files for Resident #1 (R-1) through Resident #4 (R-4). Resident files are maintained at the facility. Resident file has the required documents. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent For Medical Treatment and Preplacement Appraisal Information, Resident Pre-Appraisal. Resident Rights were observed. Disaster Preparedness: The facility has a Disaster Preparedness plan in place. Last drill was conducted on 05/01/25. Health Related Services/Incidental Medical Services: The medications are stored and locked. R-2 has (2) over the counter medications (Zyrtex 10 mg and PreserVision AREDS 2 formula) without a physician’s order. Deficiency cited. Deficiencies cited. Refer to LIC 809D. Exit interview conducted, copy of appeal rights and a copy of this report was provided to Shaunda Williams.