Routine inspection·January 22, 2025

Licensing Program Analysts (LPAs) Rebecca Borunda and Hannah Rodgers conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPAs were greeted by, identified themselves to, and explained the purpose of the visit with Licensee Rigoberto Garcia. The facility is licensed for a maximum capacity of 6 residents, 5 of which may be non-ambulatory. The facility has a pending hospice waiver increase for 6 residents. During today’s visit, the facility had a census of 6 residents, 2 ambulatory, 4 non-ambulatory. 3 residents were receiving hospice services. The Administrator for the facility is Rigoberto Garcia and their certificate was valid and current. During today’s visit, LPAs toured the facility and inspected each room of the facility, including resident and staff rooms, bathrooms for resident and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed on the premises. LPA did not observe any aspects of delayed egress or secured perimeter. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured at 115.9 degrees Fahrenheit in a common bathroom and 112.6 and 106.2 degrees Fahrenheit in private bathrooms. The facility’s internal temperature was measured at 71 degrees Fahrenheit. LPAs observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. According to Rigoberto Garcia, no firearms or weapons are stored on the premises. LPAs also observed locked storage for resident medications and resident and staff files. LPA observed a minimum of a 2-day supply of perishable food and a 7-day supply of non-perishable food present at the facility. The facility refrigerator was kept at 30 degrees Fahrenheit, and the facility freezer was kept at X degrees Fahrenheit. LPA observed linens and hygiene products provided to the residents that are in good repair and sufficient to meet their needs. Staff present at the facility during the time of the inspection had a criminal background clearance, were associated to the facility, and had a first aid certificate. Continued on LIC809-C page… LPAs reviewed multiple resident and staff records. Each resident record was complete and contained a signed admission agreement, initial physician’s report and medical assessment, documents regarding safeguarding personal property, and personal rights. Each staff file was complete and contained a personnel record, first aid certificate, fingerprint clearance and association, and a health screening. LPAs spoke with staff and residents present at the facility during the time of the inspection. The Licensee will submit copies of the LIC500 Personnel Report, LIC610E Disaster Plan, and current liability insurance to the Department within 15 business days. LPAs provided Licensee with an LIC9102TV Technical Violation regarding medication storage and an LIC9102TV regarding medication labels. LPAs also provided verbal guidance regarding the updated dementia regulations that became effective 1/1/2025. No deficiencies were cited on today’s date. An exit interview was conducted with Licensee Rigoberto Garcia, whose signature below confirms receipt of a copy of this report, the two LIC9102TVs, and the Licensee Appeal Rights (LIC9058 3/22).