Routine inspection·July 27, 2022

Licensing Program Analyst (LPA) Arielle Pascua and Licensing Program Manager (LPM) Stephenie Doub arrived at this facility on 07/27/2022 at 9:00am to conduct an unannounced annual visit. LPA Pascua and LPM Doub were greeted by Marilyn Ramones and was told to contact the Administrator at this time to let them know that Licensing was present. LPA Pascua and LPM Doub later met with Facility Designated Administrators, Mario and Juliet Ramones and stated the purpose for today’s visit. Census was currently 3. Two residents were on hospice at this time. Administrator holds current certificate and expires on 04/02/2024. The facility is licensed for six non-ambulatory. This facility also holds a hospice waiver for 6 residents. A tour of this facility was conducted. The facility has a main entrance screening point. The facility has a 30 day supply of PPE. The facility conducts disinfecting cleaning daily. Fire extinguisher appeared to have been annually inspected on 07/28/2022. The kitchen area was toured. LPA observed a sufficient seven days of non-perishable as well as two days worth of perishable food supplies in the main kitchen. The exterior of the physical plant was toured. The two exit gates were inspected and perimeter fence was observed to be stable. The common areas were toured. Living room, dining area and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time. Laundry area was toured. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. A tour of 3 resident rooms were conducted. Resident furniture was observed to be sufficient to meet resident needs at this time. A staff room was also toured. A linen closet was located in the hallway and presented a sufficient amount of linen to adequately supply and meet the needs of the residents at this time. A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. Grab bars were present at this time. LPAs observed a locked centralized stored medication cabinet located in the hallway. Along with the administrator, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components at this time. The following forms and documents were requested to be updated and submitted into CCL: -LIC 308 -LIC 400 -LIC 500 -LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Code. Appeal rights were printed and a copy of this report was given to the Facility Designated Administrator. Exit Interview.