Routine inspection·May 6, 2025

Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was allowed entry and discussed the purpose of the visit with Administrator Jullia Arida. According to the facility’s license, the facility has a maximum capacity of six (6)residents. Four (4) of whom may be non-ambulatory and one (1) may be bedridden. Hospice waiver approved for four (4) residents. LPA, accompanied by Administrator 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. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. Both the ambient and hot water temperature were at compliant readings The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to clients. Medications were labeled, as required, and stored in locked areas. Their are no bodies of water on the premises. Per Administrator, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. [CONTINUED ON LIC 809-C] LPA reviewed multiple staff, resident and facility records/files. Records review revealed no admission agreement on file for three residents. Records review revealed facility staff did not meet the 20 hours of yearly training required by the Department. Records review further revealed staff contact information missing from staff files. Confidential records were observed to be stored in locked areas. Based on interviews, observations, and record review, deficiencies were observed and cited on the attached LIC 809D. An exit interview was conducted with Jullia Arida whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.