Routine inspection·January 30, 2025

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection. LPA met with Teresita Heard, Administrator, and explained purpose of inspection. The facility is licensed for (6) non-ambulatory residents, (1) of whom may be bedridden, and has a hospice waiver approved for (6) residents. Currently there are (3) residents and there are no residents under hospice. During today's inspection, a home health nurse arrived to speak with a newly admitted resident, who was visiting with their family. LPA observed (1) other resident in the common area and (1) in her resident room. LPA and Administrator toured the interior and exterior of the facility including the common areas, (2) private resident bedrooms, (2) shared resident bedrooms, (2) resident bathrooms, kitchen, and laundry area. The Administrator and staff live in the facility. LPA observed the home to be clean, safe, odor free, in good repair. Sharps, toxins and medications are locked in the kitchen. There is sufficient 2+day perishable food, including much fresh produce, and 7+day non-perishable supply of food. There are additional toxins locked in the laundry room and sufficient paper/incontinent supplies as well as linens/blankets/towels. There is a complete First Aid kit. Inside temperature was observed to be 72* F. The fire extinguisher was last serviced 4/29/24, and the smoke/monoxide alarms are in working order. Hot water temperature measured 120*F in the kitchen and in a resident bathroom. LPA advised the allowed range is 105*F-120*F. There are games/activities on site and sufficient indoor and outdoor space, including covered seating. There is (1) unlocked exit gate and exit doors have alarms. There is a garden in the back area. LPA reviewed (2) resident files and (3) staff files. Files were organized and contained current documentation. Medications were reviewed for (1) resident. Orders match medications being given and documentation is current. There is documentation for completed initial and ongoing staff training, including current First Aid/CPR certifications. All staff are cleared and associated. Administrator certificate #6003786740- exp 7/7/25. The facility just obtained an updated Dementia Care Compliance plan from an approved vendor. There were no deficiencies observed during today's inspection. Exit interview. Copy of report provided to Administrator.