Routine inspection·September 15, 2025

Licensing Program Analysts (LPA) S Vaid conducted the required annual inspection. LPA met with Grace Obar who allowed entry into the facility. Licensee / Administrator Rona Lomeda was notified and arrived shortly after and discussed the purpose of today’s visit. LPA toured the facility and did not observe any health and safety issues. The facility is licensed to serve the elderly ages 60 and above. Fire clearance approved for six (6) non-ambulatory and one (1) bedridden in bedroom #5. Hospice waiver approved for six (6). The facility is a single-story building located in a residential area with five (5) resident bedrooms, two (2) resident bathrooms, kitchen, dining room, living room, front yard, backyard, and attached garage without entry from main house. Currently there are four (4) non-ambulatory residents currently residing, zero (0) residents are currently bedridden. LPA utilized the Compliance and Regulatory Enforcement tools for the visit today and observed the following: 1.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. 2.Operational Requirements: The fire clearance is approved for six (6) non ambulatory and hospice waivers for six (6). There are currently four (4) residents of which four (4) are non-ambulatory. Staff are adhering to operational requirements. Continued on 809C................... 3.Physical Plant & Environment Safety: LPAs toured facility grounds. Smoke alarms and carbon monoxide detectors were observed. Both, smoke alarms and carbon monoxide detectors were tested and operable. Fire extinguishers are located throughout the premises (service date of 07/21/25). Water temperature measured as per Title 22 regulations, within 105-120 degree F. Bathrooms had non-skid surfaces and grab bars. Cleaning solutions, and disinfectants are locked and inaccessible to clients. Pesticides and cleaning supplies are kept away from the food preparation areas. 4.Staffing: Facility has reasonable staffing; staff was observed assisting residents with their activities. 5.Personnel Records-Training: Staff files are maintained at the facility. LPA reviewed staff files for S-1 through Staff #4 (S1-S4). Staff have their Health and TB Screening on file. Association and clearance. 6.Resident Rights-Information: Resident rights are included in Resident files. The let-us-no and ombudsman posters were observed to be posted in the living room. 7.Planned Activities: Activity schedule/calendar is posted inside the activity room. Staff does activities with residents daily, exercise, karaoke. 8.Food Service: Dining area has adequate seating. Plates, cups and utensils are kept cleaned and stored properly. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Knives are locked and inaccessible to clients. There are sufficient food supplies of 2-day perishable and (1) week of non-perishable items. The food is properly stored in the refrigerator. 9.Incidental M&D: The medications are centrally stored in the medication room and in bubble packs and/or original containers. Medications are administered as prescribed by the Physician. 10.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. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Functional Capabilities, and Resident Rights were observed. 11.Disaster Preparedness: The facility has the Emergency Disaster Plan in place. Fire Drill was conducted 7/15/25. 12.Clients with SHN: Facility does not use manual restraints at this facility. No deficiencies observed on today's visit. Exit interview was conducted with licensee/administrator Rona Lomeda. Due to printer issues, LPA Vaid will mail report via USPS.