Routine inspection·July 19, 2024

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Caregiver Jesus Lopez. Administrator Jay Pichika arrive shortly after. According to the facility’s license, the facility has a maximum capacity of six residents, of whom all may be non-ambulatory, one of which may be bedridden. LPA toured the interior and exterior of the facility and inspected each room. There were multiple issues with the physical plant- room 6 walkway was semi-obstructed with construction tools, a large mirror and construction debris. Additionally there was a toilet in front of the closet which contained dark brown water. Double vanity outside room six is not in working condition, per residents has not worked in weeks. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Sink in double vanity was not draining water. Shower floors had dark mold and non-slip pads were slimy. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications labeled and locked as required. No pool or body of water was present. Water temperature was measured at 113 degrees F. Per Jay, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit was complete. Resident records reviewed did not contain Needs and Services Plans. Staff records reviewed did not have current first aid training in two of two records. Additionally, LPA informed Administrator of annual fees due to the Department. Multiple deficiencies were provided on todays date and one technical violation. An exit interview was conducted with Administrator, to whom a copy of this report,(LIC9099-x3), LIC9102, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.