Routine inspection·November 7, 2024

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with caregiver, Ashley Thomas, who contacted the Administrator, Ana Maria Cai, who arrived shortly. LPA observed all (6) residents in their rooms at the start of the inspection. The facility is licensed for (5) non-ambulatory residents, (1) bedridden resident and has a hospice waiver for (2). Currently, there is (1) resident on hospice. LPA and the Administrator toured the interior and exterior of the facility including the common areas, (4) private resident bedrooms, (1) shared resident bedroom, (3) resident bathrooms, kitchen, staff room and laundry area. LPA observed the facility to be clean, in good repair and odor-free,and the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps and medications in the kitchen. Toxins are secured in the laundry room nearby. Inside temperature read 76*F, and the hot water temperature measured 108*F in the kitchen. The smoke/monoxide alarms are in working order and the fire extinguisher was last serviced 8/30/24. There are sufficient linens/towels/blankets/PPE supplies, and there is a complete First Aid kit. Residents use a pendant for call for assistance. There is (1) unlocked exit in the backyard and covered seating on the patio. There are no pools. LPA reviewed (3) resident files and observed them to be organized and contain current documentation. Medications were reviewed for (2) residents. Orders match medications, and documentation is maintained. (3) staff training records were reviewed. All staff have current First Aid/CPR and have completed the required initial or ongoing training. Administrator's RCFE Certification #6041800740-(exp 9/5/24) is pending renewal. An updated copy of liability insurance was obtained. An updated copy of LIC500, LIC308 to be provided to the Department by 11/14/24. All contact information is current. There are no deficiencies issued during today's inspection. Exit interview with Administrator. Copy of report provided.