Routine inspection (multi-day)·October 15, 2025

Licensing Program Analyst (LPA) De Leon made an unannounced Case Management Continuation Annual visit to the facility listed above. LPA met with Rachelle Tellez, Back up Administrator and explained the purpose of the visit. A tour of the physical plant was assessed, and the following was noted: Resident Rights & Information: LPA observed the license posted, Complaint Poster, Bill of Rights and Right to Residential Council, non-discrimination statement, and resident rights off the entry in the hall near kitchen. Infection Control: The facility has an infection control plan on file. The facility has PPE supplies and trains staff upon hire and annually thereafter. Medications and meals can be delivered to rooms when and if needed. Operational Requirements : The Facility is operating in compliance with the fire clearance. The facility has a license for 6 Non-Ambulatory which 1 may be bedridden in room 3. The facility provided current up to date liability insurance. All Dementia requirements are being met. Hospice wavier granted for 3. Planned Activities: Living room, dining room, and outside area with sufficient space for activities and visiting. The facility has games, magazines, book and planned activities with residents in care. Residents take part in any activity they want to. Food Service: The kitchen and pantry were sufficiently stocked with two day perishable and seven day non-perishables. Foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Emergency supply of food and water is available. Garbage cans have tight fitting covers. Refrigerator is kept at 40 F or below and the freezer at 0 F degrees. The kitchen chemicals are locked under the sink. There is a locked drawer for sharps and knives. Continued 809-C Physical plant: Facility was checked for cleanliness and condition. Walls, windows, ceilings, floors, floor coverings, and doors were checked, all in good condition. The facility maintains a comfortable temperature. The facility has 6 bedrooms designated for residents use with on suite bathrooms currently occupying 4 residents. The facility has an upstairs designated for staff only with 3 bedrooms/2 bathrooms for live in staff and 1 locked medication room with a locked medication cart. The facility is clean, safe, and sanitary. The outdoor area of the facility has outdoor furniture with shade for residents and visitors. There are gardens and walking paths. There is a locked jacuzzi with a hard top. The facility has a fenced in pool with two locked gates. Resident rooms are adequately dressed with sheets, pillowcase, mattress pad, and blankets which are in good condition. There is at least one chair, night stand, and sufficient lighting for each resident. There is enough linen available to change weekly or more, if needed. Storage cabinets have enough personal hygiene product which is provided by the licensee and all cleaning products, toxins are stored and locked away inaccessible to residents in care. Bathrooms were checked for cleanliness, secured grab bars and proper operation. All clients have their own personal restroom with proper hand washing sign, soaps, and paper towels . Incidental Medical and Dental: Medications are centrally stored in the locked medication room upstairs, and double secured in a locked medicine cabinet. Medications are checked for expiration dates, in original containers and no labels were altered. The facility uses the Medication and Destruct Records (CSMDR) and the Medication Administration Record (MAR). Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger such as sharps, and cleaners were locked separately in drawers and cupboards. The facility does not have delayed egress. The facility does have hospice and home health visits to the facility for residents in care and plans are kept up to date. There are no residents currently on oxygen. The facility is completely fenced with a large front entry/exit gate, sign is posted at gate for opening for pedestrians. Emergency Disaster Preparedness: The plan is current, and forms were posted. The facility provides disaster drills quarterly. The fire extinguishers were charged and tagged on March 15, 2025. Fire extinguishers are located in the kitchen and the hallway closet by front entry. The dual smoke and carbon monoxide detectors are present and hard wired throughout the facility. LPA interviewed 2 staff, residents were eating lunch and resting did not want to interview. Exit interview conducted and copy of report printed for Administrator.