Routine inspection·July 24, 2023

Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual inspection on 07/24/2023 at 3:00 PM. LPA met with Romona Dellroy and stated the purpose of today’s visit. LPA 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. The facility is licensed for 6 bed ridden residents, and has a hospice waiver for four. There are currently 6 residents who reside at this facility. LPA Martinez toured the facility with Romona Dellroy on 07/24/2023 at 4:00 PM. LPA Martinez reviewed three Medication Administration Records (MAR), and the MAR records were complete and maintained. LPA Martinez inspected the facility first aid kit, and the kit was complete. LPA Martinez reviewed three employee files, and files were complete and maintained. LPA Martinez reviewed five resident files and two out five files were complete. Three files were not maintained and missing admission agreements, assessments, and health certification forms. A technical violation was given, as the forms were completed, but were not filed in the residents' files. The facility has a infection control plan and has an emergency disaster plan. The facility fire extinguishers are in good repair, and last facility fire inspection was on June 30, 2023. The carbon and smoke detectors are in good repair. The last fire drill was conducted in June of 2023. The exterior of the facility is clear of derbies and outside patio is in good repair. The facility has an adequate food supply. The facility water temperature measured at 106 degrees and the facility temperature measured at 74 degrees. There were no deficiencies cited at this annual visit. An exit interview was conducted, and a copy of this report was provided to the facility.