Routine inspection·June 19, 2025

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Administrator Juliane Cruz. LPA spoke with Licensee Tonya Weaver via telephone during the visit. The facility is licensed for a maximum capacity of 6 nonambulatory residents, 1 of which may be bedridden in bedroom #1. The facility has a waiver for 6 hospice residents. During today’s visit, the facility had a census of 6 non-ambulatory residents. The Administrator for the facility is Juliane Cruz and their certificate was valid and current. During today’s visit, LPA 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 107.4 and 106.0 degrees Fahrenheit in common bathrooms. The facility’s internal temperature was measured at 79 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. According to Juliane Cruz, no firearms or weapons are stored on the premises. LPA also observed locked storage for resident medications and resident and staff files. Resident medications are stored in their original container and labelled. 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. Continued on LIC809-C page… The facility refrigerator was kept at 36 degrees Fahrenheit, and the facility freezer was kept at 0 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. LPA reviewed multiple resident and staff records. Each staff file was complete and contained a personnel record, first aid certificate, fingerprint clearance and association, and a health screening. Each resident record was complete and contained a signed admission agreement, initial medical assessment, updated annual reappraisal, documents regarding safeguarding personal property, and personal rights. Review of Resident 1's (R1) medical and care assessments as well as discharge paperwork dated April 2025 revealed that R1 had a diagnosis of a gastronomy tube and was only receiving home health services. Interviews with the Administrator and Licensee confirmed that R1 was not receiving hospice services and caregivers had been trained by home health staff on proper gastronomy tube care. LPA provided guidance and consultation with Administrator regarding regulation changes that became effective 1/1/2025. The following deficiency was cited for prohibited health conditions and noted on the attached LIC809-D page. An exit interview was conducted with Licensee Tonya Weaver and Administrator Juliane Cruz, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).