Routine inspection·May 16, 2025

On May 16, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Administrator (AD) Angelina Teves was present to assist with the facility inspection on today's date. The facility is licensed for capacity of six residents over age of 60 approved for four (4) non-ambulatory, one (1) bedridden and one (1) ambulatory residents. Facility has approved hospice waiver for four (4) residents. Currently, there is one (1) Hospice resident present during today’s visit. This is a two story with a attached two-car garage facility. The facility has four resident bedrooms (two private rooms and two shared) and two bathrooms. Second story is for staff and inaccessible to residents. At around 8:15AM, LPA Tirre conducted a tour of the physical plant accompanied by Administrator Angelina Teves, and the following was observed: There is a swimming pool fenced and inaccessible to residents 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, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured between 109.5 to 116.6 degrees F. A comfortable temperature of 73 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 one fire extinguisher which were mounted and fully charged. 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, and sanitizing stations in common areas and restrooms. LPA observed the facility has supply of Personal Protective Equipment (PPE). All mandated inspection control posters such as see something say something, Personal Rights, Emergency Disaster Plan, and Theft & Loss policy were posted. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on May 15, 2025. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. The facility has current liability insurance on file effective 3/22/2025 – 3/22/2026. A review of four residents (R1-R4) service files and two staff (S1-S2) personnel files revealed to be complete. LPA verified on active Administrators Certification list that the facility has the current administrator's certification on file for Angelina Teves # 7023029740 - Expiration 8/26/2026. No deficiencies during this inspection visit. An exit interview was conducted with Administrator Angelina Teves, and a copy of the report was provided.