Routine inspection·September 4, 2025

Licensing Program Analyst (LPA) Elizabeth Irra conducted an unannounced annual inspection visit. LPA was allowed entry by Maria Teresa Cerino. LPA spoke to Rocio Collado via telephone and discussed the purpose of today’s visit. This facility consists of (6) bedrooms, (1) staff/employee room, (3) full bathrooms, (1) ½ bathroom, utility room (laundry), living room, dining room, kitchen. This facility is currently approved for (12) AMBULATORY residents only. Per Ms. Collado, this facility will only be able to accommodate up to (9) residents and not (12) residents. This facility has not admitted any residents since becoming licensed. The following was discussed during the telephone call with Ms. Collado: Change in capacity- Ms. Collado was instructed to submit a new LIC 200/Application, facility sketch and a check to CDSS for the request of change in capacity. The new LIC 200 and facility sketch is to identify/reflect the total number of beds (including non-ambulatory). Request for non-ambulatory- Per Ms. Collado, there is an inspection pending with the Fire Department to move forward with this request. Ms. Collado will provide updates to LPA. Additionally, LPA briefly discussed dementia plan as potential residents with this diagnoses are considered to be non-ambulatory. This facility does not have a dementia plan in place. Refer to LIC 809C for the continuation of this report. Overdue licensing fees- LPA provided Ms. Collado the information (including PIN) to pay fees on-line today as they are due today. A copy of the facility transaction with PIN information was left at this facility and also sent via text to Ms. Collado. Liability Insurance: LPA requested a copy of the current insurance coverage. Guardian Portal- LPA discussed with Ms. Collado the requirement of having all staff finger print cleared and associated to this facility prior to accepting the first resident. Self-Assessment Guide (Residential Care Facility for the Elderly)- LPA discussed this tool and provided a copy. LPA also sent a picture of this document to Ms. Collado via text. LPA utilized the Compliance and Regulatory Enforcement (CARE) tool: Infection Control: Facility has an Infection Control Policy in place. Operational Requirements: This facility has not admitted any residents since becoming licensed. Physical Plant & Environment Safety: LPA toured facility grounds. Fire smoke alarms and carbon monoxide detector observed. The fire extinguishers observed and appeared to be full. Bedrooms have the required furniture. Bathrooms have non-skid surfaces and grab bars. Hot water temperature (156.4* in bathroom near bedroom #5 and 152.2 the other bathrooms (Advisor Note- Technical Violation issued as there are no residents residing at this facility. Staffing : This facility has not admitted any residents since becoming licensed. Personnel Records-Training : This facility has not admitted any residents since becoming licensed. Resident Rights-Information: This facility has not admitted any residents since becoming licensed. Planned Activities: This facility has not admitted any residents since becoming licensed. Food Service: This facility has not admitted any residents since becoming licensed. Resident Records-Incident Reports: This facility has not admitted any residents since becoming licensed. Disaster Preparedness: Facility has a disaster preparedness plan in place. Health Related Services/Incidental Medical Services: This facility has not admitted any residents since becoming licensed. Exit interview conducted, copy of appeal rights and this report was provided to Maria Teresa Cerino.