Routine inspection·May 29, 2025

On 05/29/25, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with administrator Salote Lewis and explained the purpose of the visit. The current census is 6 with 3 facility staff. This facility is a single story building licensed to serve six (6) non-ambulatory residents and approved for 2 hospice waivers. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Lee observed the facility to be free of odor, clean and in good repair. LPA Lee observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA Lee toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 115.3 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in the kitchen and was last serviced on 05/01/25. The last fire drill was conducted on 05/20/2. LPA Lee observed the facility has a has a public telephone in the and kitchen the facility has the required posters posted. Facility thermostat was observed at 78 degrees Fahrenheit. LPA Lee observed toxins located in the laundry room and kept locked and inaccessible to residents. LPA Lee observed sharp knives kept locked in the kitchen cabinet and inaccessible to residents. Continued LIC 809-C LPA Lee checked medication storage and found medication to be locked away and inaccessible to residents. LPA reviewed 3 out of 6 resident medications and medication administration record (MAR) and it was complete. The first aid kit was checked and contained the required components. LPA Lee requested resident and staff files for review. LPA Lee reviewed 5 out of 5 resident files and they were complete. LPA Lee reviewed 2 staff files, and it was also complete. The following documents will be email to LPA by 06/05/24 end of day 5:00 PM: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) LIC 500 Current Personnel Report As a result of this annual visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted with administrator Salote and a copy of these LIC 809 reports were provided to the facility.