Routine inspection·July 24, 2025

Licensing Program Analyst (LPA) Galarza conducted an unannounced annual inspection visit. The purpose of the visit was explained to caregiver Andres Hernandez. The facility serves elderly residents ages 60 and older. The following were observed/inspected: Infection Control: The Infection Control Plan was reviewed and includes environmental cleaning and disinfection activities. Facility has sufficient Personal Protective Equipment. Operational Requirements: A Dementia and hospice waiver for 4 residents has been approved. The facility has a fire clearance for 6 non-ambulatory residents. Facility does not handle resident P & I monies. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current and expires 8/26/2025. Physical Plant/Environment Safety: The facility is located in a residential neighborhood that consists of 4 resident rooms, 2 bathrooms, dining room/ living room, office, laundry room, medication/storage room, outdoor patio area, and detached garage. Smoke and carbon monoxide detectors were tested and are operational. The facility has three (3) fire extinguishers. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. The facilit y has a 1st Aid Kit and Manual. The last Emergency Disaster drill was conducted on 5/30/2025. Cleaning supplies and knives were locked. Exit doors are free of any obstruction and there are no pools or large bodies of water. Medication pills in dispensing cups were observed in an unlocked kitchen drawer. Alcohol/alcoholic drinks were observed unlocked in the bottom kitchen cabinet which pose a safety risk to Dementia residents. Staffing: A total 8 staff members provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificate expires 11/14/2025 Assistant Administrator's certificate expires 3/10/2026. Staff have criminal background clearance and training. Six (6) staff files were reviewed. Proof of staff training, health clearance, and 1st Aid/CPR training is current. Resident Records/Incident Reports: A total of five (5) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisals, TB clearance, Physician's Orders, medical consent. RCFE and Ombudsman complaint posters are posted in the dining area. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Two residents have modified diets. Incident Medical and Dental: Centrally Stored Medication records and medication inventory was reviewed . 30-day supply of medications was observed. Medical and dental transportation is provided by family. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. Facility has a First Aid Kit and Manual. Residents with Special Health Needs: Three (3) resident receive hospice services and one (1) resident receives home health services. Three (3) residents have Dementia. No residents have prohibited health conditions. Half and full bed rails for mobility assistance physician orders are in place. Per Title 22, deficiencies were observed. Refer to LIC 809D. An exit interview was conducted with caregiver Andres Hernandez. A copy of the report was issued.