Routine inspection·March 13, 2025

Licensing Program Analyst (LPA) Shannan Hansen conducted an unannounced required annual inspection of this facility and met with Licensee/Administrator Elvira Gazal. Facility has 5 residents in care, 1 receiving hospice care and 4 residents with dementia diagnosis. At approximately 8:50 AM LPA toured the building and grounds with Administrator, which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. Some residents have call buttons which sound in kitchen area. All notices that are required to be posted have been posted and are in a highly visible area. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored in locked hallway closet and in locked garage. Water temperature measured between 112.6 degrees F and 116.9 degrees F, within regulation between 105 and 120 degrees F in 2 out of 2 faucets accessible to residents. There was an ample supply of cleaners, hygiene products and paper products available for residents. Resident bathrooms had required slip resistant mats and grab bars. Fire extinguisher inspected was last charged on 12/18/2024. Smoke detectors and Carbon Monoxide detector was tested and found to be in working order. Facility has fire pull station located by front door. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure in kitchen along with small refrigerator with lock for medication. At approximately 9:30 AM, LPA reviewed 5 of 5 resident records and found 5 of 5 residents have current physician’s reports or care plans, as well contained current and signed admission agreements and physician’s orders on file. At approximately 10:30 AM, all staff and others needing background clearance and associated have been. LPA reviewed 4 of 4 staff records. 4 of 4 records contain documentation of completed training records as required. Evidence of current first aid and CPR training were observed. Continue on LIC809-C Continued from LIC809 Medications were centrally stored in locked cabinet in the facility kitchen. The Medications of 2 out of 2 residents were found to be given according to physicians’ directions on 3/13/2025 at approximately 10:15 AM. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be complete and accurate. At approximately 11:00 PM, LPA reviewed the facility emergency disaster plan with staff. Facility has a generator to supply power during an outage. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducts quarterly disaster drills with the last disaster drill conducted on 2/1/2025. Elvira Gazel Administrator Certificate 7002386740 expires 1/12/2026. No deficiencies cited during today’s inspection LPA Hansen is requesting Licensee to update and submit the following documents to CCL by 3/28/2025: LIC 308 Designation of Responsibility (if changed) LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (if changed) LIC 9020 Register of Facility /Resident’s Control of Property – updated Lease Copy of Administrator’s Certificate Proof of Liability Insurance