Routine inspection·April 17, 2025

On April 17, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required Annual visit using the CARE Inspection Tool. LPA Tirre was greeted by staff and granted entry after stating the purpose of the visit. Administrator (AD) Clemencia Atencio arrived shortly after to help assist with the facility inspection on today's date. The facility is licensed for six (6) non-ambulatory residents, one (1) bedridden with approved hospice waiver for six (6) residents. Currently, there are two (2) Hospice residents present during today’s visit. This is a single story home with attached garage facility. The facility has seven bedrooms (six private resident bedrooms and one staff room), six full bathrooms and one half bathroom. At around 7:56 AM, LPA conducted a tour of the physical plant accompanied by Administrator Atencio, 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, 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 toxins 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 emergency supply of food and water. Fire extinguishers were mounted and was fully charged. Facility has three fire extinguishers. 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 were posted. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on April 14, 2025. The facility had operational smoke and carbon monoxide in bedrooms and common areas. The facility has current liability insurance on file effective 8/25/2024 – 8/25/2025. The facility is current on Community Care Licensing annual dues. A review of six residents (R1-R6) service files and four staff (S1-S4) personnel files revealed to be complete. The facility has the current administrator's certification on file for Clemencia Atencio # 6034464740 - Expiration 04/19/2025. No deficiencies during this inspection visit. An exit interview was conducted with Administrator Clemencia Atencio, and a copy of the report was provided.