Routine inspection·October 19, 2023

Licensing Program Analyst (LPA) Avelina Martinez and Scott Brooks made an unannounced visit to this facility to conduct an annual inspection on 10/19/2023 at 2:25 PM. LPA Martinez met with Renee Ates and stated the purpose of today’s visit. LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. Administrator holds current certificate and expires in September of 2024. The facility is licensed for 6 non-ambulatory clients. There are currently 4 clients who reside at this facility. The facility has a hospice waiver for 1. LPA Martinez toured the facility with on 10/19/2023 at 2:25 PM. LPA Martinez reviewed two employee files and two client files, and the files were maintained. LPA Martinez reviewed one medication administration record, and the record was maintained. First Aid Kit was complete. The fire extinguishers, smoke detectors, and carbon detectors were in good repair. Facility has cameras mounted in the common areas. The cameras are not in working order, however, facility sketch should be updated to reflect mounted cameras. LPA Martinez requested a copy of surety bond and liability insurance The facility has infection control plan and emergency disaster plan. All requested document should be emailed to LPA Martinez by October 26 2023 by 5 PM. LPA observed the facility to have an adequate food supply. The following items were not in good repair: Window screens, sliding glass door screens, exterior fence, wheelchair ramp, emergency exit gate/door, freezer had frost bite build up. The items should be repaired by November, 09, 2023. A Plan of correction visit will be conducted to inspect repairs. The facility water temperature measured at 105 degrees and facility temperature measured at 78 degrees. As a result, of this annual visit, the facility was cited for fire clearance and Maintenance and Operation. Citations can be found on the 809-D page. An exit interview was conducted, and a copy of this 809 report, 809-D Page, and appeals rights were provided to the facility.