Routine inspection·July 28, 2025

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Caregiver Ester Villar. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, one (1) of which may be bedridden. Additionally, the facility is approved for two (2) hospice waivers. During today’s inspection there were five (5) residents in care. Administrator Angie Norton arrived later during the visit. LPA and Caregiver Villar toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant: Bathroom sink in common bathroom 1 was 105F and common bathroom 2 read at 107F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. Knives were locked an kept inaccessible to residents in care. [Continued on LIC 809-C] [Continued from LIC 809] No toxic chemicals or poisons were accessible to clients.  Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Caregiver Villar, no firearms or ammunition are kept at the facility. Smoke and carbon monoxide detectors as well as emergency lighting were all in working order. Last staff fire drill conducted was on 2/25/25. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. When inspecting the facility's fire extinguishers, LPA noted that there was no service tags on the extinguishers and the receipt of purchase was dated 8/21/2022. Administrator Norton stated they purchase new extinguishers annually but did not retain the receipt. As date of purchase could not be verified, a deficiency is being cited per Title 22 regulations and noted on the attached LIC 809D. In addition, a Civil Penalty is being assessed for a Zero Tolerance Violation regarding Fire Safety and are noted on the attached LIC 421IM in the amount of $500. LPA interviewed two (2) staff and two (2) clients, and interviews did not reveal any licensing or regulatory concerns. LPA reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. One deficiency was cited during the inspection. An exit interview was conducted with Administrator Norton to whom a copy of this report, the LIC 421IM, and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.