Routine inspection·August 21, 2025

On 8/21/2025, Licensing Program Analyst (LPA) Cynthia Tamayo arrived unannounced to conduct a Required - 1 Year visit. LPA met with licensee, Magie Quirez, S1 and explained the purpose of the visit. An entrance interview was conducted. Administrator Certificate Number 7021127740 for Grace Nicole Quierez is #7021127740 and expires 12/9/2025. The facility is approved for age range 60 and over. Licensed to serve up to 6 no ambulatory residents. Hospice waiver on file for 2 residents. The current census is 5. There are currently no residents on hospice. LPA toured the physical plant was conducted with S1 to ensure residents’ health and safety and the facility is in compliance with Title 22 regulations. The following was observed: KITCHEN: Appliances and fixtures were clean and functional. The facility had ample supply of perishable and non-perishable food. Refrigerator temperature was at 45 degrees F and freezer temperature was at 0 degrees F. Knives and other sharps are locked inaccessible in a drawer. Kitchen and house cleaning supplies are stored in a locked cabinet located under the sink. Water temperature was tested and both measured at 110.4 degrees F. Resident Bennie Davenport (R1) administers their own insulin medication. LPA observed insulin medication is properly stored in a lock box in the refrigerator. Continued on 809-C COMMON AREAS: Common areas include the Living Room and Dining Room. All furniture was observed to be clean and in good condition with enough seating for six residents . There was space to accommodate both indoor and outdoor activities. LPA noted an Activity Calendar and activity storage in the entrance bulletin board. One (1) fire extinguisher was observed throughout the common area and was last serviced on 10/2024. Combination smoke detectors and carbon monoxide detectors were working and operational. EXTERIOR: Exterior passageways were clean and clear of any obstructions. Outdoor furniture observed to be in good condition. Clients are supervised at all times when they are outside. BEDROOMS: LPA inspected facility bedrooms. The facility has 5 total client bedrooms. All bedrooms were observed to contain furniture, bedding and linens within regulation. Extra linens are stored in the hallway cabinet. Client bedrooms had no visible hazards observed. Resident in room #3 stated they prefer sleeping on a recliner over a bed. S1 stated son requested recliner for R1 upon admission. There is no staff bedroom. LPA reviewed regulation with S1 regarding the requirement to have wake staff at all times. BATHROOMS: All bathrooms were observed to be clean and sanitary, and supplied with paper and hygiene products. Water temperature was tested and both measured at 110 degrees F. MEDICATION REVIEW: LPA reviewed medications which are centrally stored in a locked cabinet in the hallway. All medications were stored and administered in compliance with regulation. RECORD REVIEW: LPA reviewed five (5) resident file records. Resident records were reviewed for, but not limited to care plans, physician's report, and admissions agreement. Resident files reviewed contained all required documents. LPA reviewed three (3) staff records during today's visit. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All staff records reviewed were in compliance at the time of the visit. continued on 809-C INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility's infection control plan as well as the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are within regulation. Both documents were observed to be complete and recently updated. Personal Protection Equipment (PPE) and extra emergency supplies, including emergency food and water, are stored in the garage. LPA reviewed reporting requirements with S1. S1 stated they understood and will follow reporting requirements. The following documents were collected during this visit: (1) LIC 610E Emergency Disaster Plan (2) Proof of Current Liability Insurance (3) LIC 309 Administrator Organization As a result of this annual visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted with S1, and a copy of these LIC 809 reports were provided to the facility.