Routine inspection·August 31, 2021

Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced annual inspection with an emphasis of infection control. LPA Gardner met with Administrator Favieruth Jimeno and toured the facility. LPA Gardner inspected the facility and the following was observed: The home is one story, four bedroom, two bath home with a living room, dining room, and kitchen. The smoke/carbon monoxide detectors were tested and observed to be operational. Towels, linens were observed and appeared to be sufficient for residents in use. The residents rooms were furnished with bed, dresser, chair and lighting for residents comfort. The residents medication are stored in a locked cabinet in the kitchen. The knives are kept with the cleaners under the kitchen sink in a locked cabinet. LPA Gardner observed the kitchen to be supplied with adequate plates, cups, dishes and silverware, as well as pots, pans and serving bowls for residents use. The food supply was inspected and met the minimum requirement of 7 days non-perishable and 3 days perishable foods. The backyard is fully fenced and has chairs and shade for residents use. During the inspection LPA Gardner asked Ms. Jimeno about the residents. Ms. Jimeno stated that the facility is approved for 6 residents, of which 2 can be on hospice. Ms. Jimeno indicated that she currently has 3 residents on hospice. A records review indicated that the 3rd hospice resident, R1, was admitted on 5/31/21, and began receiving hospice care on 8/10/21. During the inspection LPA Gardner reviewed infection control practices and procedures with Ms. Jimeno. An exit interview was conducted and a copy of this report, along with LIC 809D and appeal rights were reviewed with and provided to Ms. Jimeno.