Routine inspection·February 20, 2025

On February 20, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by caregiver and granted entry after stating the purpose of the visit. Administrator (AD) Russel Cruz was present to assist with the facility inspection on today's date. Licensee/Administrator Charles Pham arrived to facility shortly after. The facility is licensed for five (5) non-ambulatory residents, one (1) Ambulatory, one (1) bedridden with approved hospice waiver for two (2) residents. Currently, there are no (0) Hospice residents present during today’s visit. This is a single story with a two-car detached garage home. The facility has six bedrooms and two bathrooms LPA conducted a tour of the physical plant accompanied by Licensee/Administrator Charles Pham and Administrator Russel Cruz , and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 114.9 degrees F. A comfortable temperature of 74 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Facility has supply of emergency food and water. Facility has a fire extinguisher which was charged and mounted. A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance. CONTINUED on 809C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on 12/2/2024. The facility had operational smoke and carbon monoxide in bedrooms and common areas. The facility has current liability insurance on file effective 6/28/24 - 6/28/25. The facility is current on Community Care Licensing annual dues. A review of four residents (R1-R4) service files and two staff (S1-S2) personnel files revealed to be complete. The facility has the current administrator's certification on file for Charles Pham - Expiration 5/19/2025 No deficiencies during this inspection visit. An exit interview was conducted with Licensee/Administrator Charles Pham, and a copy of the report was provided.