Routine inspection·March 18, 2024

On today's date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting a required Annual inspection. LPA was greeted and granted entry into the facility by Caregiver 1 (CG1). LPA Quiroz called and spoke to Licensee/Administrator (L/AD) Lisa Derrick who indicated being out of state due to a Family emergency and available via telephone. This is a a Residential Care Facility for the Elderly, licensed to provide services to six(6) Non Ambulatory residents and has a hospice waiver for (3) three residents. There are currentl six (6) residents in care at this time of which 3 are receiving hospice care services. There are no active COVID-19 cases in the facility at this time. Administrator Lisa Derrick has an Administrator Certificate with expiration date of May 4, 2024. LPA Quiroz along with (CG1) toured the interior and exterior of the facility. During today's inspection tour, LPA Quiroz observed 6 of 6 Residents interacting with staff in living room area and eating lunch consisting of: Grilled cheese sandwich, macaroni salad, orange slices and water. LPA Quiroz interacted and interviewed with Caregivers and 6 of 6 residents during today's visit. LPA Quiroz inspected resident's bedrooms and bathrooms. The water temperature in 2 of 2 resident's bathrooms were recorded to be between 116.8-118.4 degrees Fahrenheit. LPA Quiroz inspected resident's bedrooms and appeared to be clean. Facility temperature in resident's bedrooms and throughout the facility was recorded to be within normal limits. LPA Quiroz observed the emergency and disaster and evacuation plan. Facility has limited supply of emergency food, water and PPE in the garage area readily available for staff and residents in care. Fire extinguisher observed last serviced on 10/2023. LPA Quiroz observed functional and operational washer and dryer in the garage area. LPA Quiroz toured the outside of the facility and observed seating and shaded area in the backyard for residents and visitor's enjoyment. LPA Quiroz not able to review resident and personnel records due to locked and secured files, and staff not having key to the files. This was verified with (L/AD) Derrick who indicated "I'm out of state and the staff don't have access to the files." (See LIC 809-D) CONTINUED LIC 809-C... CONTINUED...During today's facility tour, the following were not observed: Facility license and PUB 475 Poster "If you see something say something." This was verified with (L/AD) Derrick (SEE LIC 9102-TV) During today's visit, LPA Quiroz provided Consultation on Title 22 and Infection control. An exit interview was conducted with (AD) Derrick and a copy of this report, LIC 809-D pages, Appeal Rights, LIC 9102-TV and LIC 811- Confidential names, were provided at exit.