Routine inspection·August 4, 2025

Licensing Program Analyst (LPA) Kimberly Ramirez conducted the required annual inspection. LPA Ramirez identified herself and was greeted by Rosalina Gonzalez. Care Manager Victora Serna arrived within the hour. This facility is licensed to serve six (6) residents over the age of 59, of which four (4) may be non-ambulatory in bedrooms# 2,3,4,5; and (1) may be bedridden in bedroom#3. This facility may retain no more than six (6) hospice residents. There was one (1) resident under hospice care during the time of inspection. LPA Ramirez observed three (3) staff providing care and supervision during inspection. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. LPA Ramirez observed carbon monoxide detectors in the living room and smoke alarms in hallways. LPA Ramirez inspected five (5) resident rooms. All resident bedrooms contained the required furniture, linens and lighting. LPA Ramirez observed postings encouraging proper hand washing etiquette in restrooms. LPA Ramirez observed grab bars near toilets. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. SEE 809-C Food Service: LPA Ramirez observed a sufficient supply of nonperishable foods for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C). Planned Activities: LPA Ramirez observed sufficient space to accommodate indoor and outdoor activities. LPA Ramirez observed staff and resident engaging in cognitive abilities games during inspection. Residents Rights-Information: LPA Ramirez observed the following postings in common areas throughout the facility: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Ramirez observed the facility land line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D) in place. The last documented emergency drills were conducted on 06/23/2025 & 05/4/2025. LPA Ramirez observed facility sketches with exits and emergency exits routes upon entrance of facility. LPA Ramirez observed emergency food supply in laundry room. The emergency water supply was in the garage. Residents with Special Needs: No large bodies of water were observed. LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” was observed. LPA Ramirez observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices were observed to be in working order. Health Related Services/Incidental Medical Services: Medications are centrally stored in medications cart and in bubble packs and/or original containers. The facility uses the Medication Administration Record (MAR) log to document medications given. The facility provides incidental medical services. Staffing: Administrator Certificate for Tony Santos expires 02/20/2026. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Infection Control: There are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. SEE 809-C Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez observed CPR and First Aid for two (2) out of the two (2) personnel records reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for two (2) out of the two (2) personnel records reviewed. LPA Ramirez did not observe documentation of required annual training in personnel files. During the annual inspection on 6/16/2024, LPA Ramirez issued a Technical Violation based on this observation and advised Care Manager Serna on the importance of maintaining documentation of staff training in personnel records. LPA Ramirez will now issue a Type B deficiency for lack of compliance with regulation 87411(c)(6). Resident Records/Incident Reports: LPA reviewed Resident files for Resident #1 (R-1) through Resident #6 (R-6). Resident files are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. Operational Requirements: This facility is licensed to serve six (6) residents over the age of 59, of which four (4) may be non-ambulatory in bedrooms# 2,3,4,5; and (1) may be bedridden in bedroom#3. During record review, LPA Ramirez observed six (6) out of six (6) physician reports revealed all six (6) residents were non-ambulatory. On 8/4/25, around 7:30am, prior to LPA’s arrival; one (1) of the six (6) residents passed away while on hospice care. LPA Ramirez will issue one (1) Technical Advisory based on this record review. LPA Ramirez spoke with Administrator Santos over the telephone and advised her on the facility’s responsibility to follow their approved fire clearance. This facility may retain no more than six (6) hospice residents. There is one (1) resident under hospice care. One (1) deficiency was observed during inspection and one (1) Technical Advisory was issued. Exit interview was conducted. A copy of this report, 809-D, LIC 9102, and appeals rights were provided.