Routine inspection·April 2, 2025

Licensing Program Analyst (LPA) Debbie Palacios made an unannounced visit to the facility to conduct a required annual inspection. LPA met with House manager Ahnna Hayes who was informed of the purpose of the visit. The facility has a fire clearance for six (6) ambulatory only and serves adults age range 60 and over. Waiver granted for hospice care for three (3). House Manager was the only staff present during the visit and has a criminal record clearance and is associated with the facility. LPA toured the facility with House Manager and reviewed records. During the tour, LPA observed the facility is made up of a one (1) story home with three (3) resident bedrooms, one (1) staff room, two (2) bathrooms, a living room, dining room, kitchen and attached garage. All resident's bedrooms had required furniture and lighting. LPA toured the facility's exterior and observed outdoor pathways were free of obstructions. Outdoor shaded seating area is also available for the residents in care. LPA observed a hallway cabinet filled with clean towels, blankets, and linen, available for the residents. LPA toured the kitchen and observed the facility has a 2-day supply of perishable foods and more than a 7-day supply of non-perishable foods, which are stored in a safe and healthful manner. LPA toured the garage and observed an additional refrigerator with perishable foods. LPA also noted the facility secures additional cleaning solutions, laundry detergent, and disinfectants in the locked garage. House Manager tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational . Medications are secured in a locked cabinet stored in the hallway closet. Exit signs, emergency contact information, resident's personal rights, and complaint information are visibly posted near the entrance. Staff files reviewed include but not limited to have personnel records, required training, and valid first aid/CPR certification. Administrator Certificate is valid until 09/14/25. LPA was unable to review the facility's Fire Drill logs and earthquake drill due not having the physical document or file in the facility (Deficiency Cited). Resident files included but are not limited to signed admission agreements, pre-placement, personal rights, house rules, needs and service plans, and physician reports. Facility sketch, LTCO, CCL complaint poster, license and emergency disaster plan is posted on a wall in the living room. Based on facility missing Fire and Earthquake drill documentation, a deficiency will be cited. An exit interview was conducted. A copy of this report, LIC 809-D, and the appeal rights were provided to House Manager Ahnna Hayes.