Routine inspection·October 10, 2025

Licensing Program Analyst (LPA) Rankin arrived at 8:55 am to conduct a 1-year annual visit to the facility above. LPA met Administrator/Licensee Miriam Salamanca and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with. The following was inspected and noted during the annual visit: Physical Plant & Environmental Safety: The facility has 3 bedrooms and 2 bathrooms, currently occupying 2 residents. The facility is clean and sanitary. The facility has smoke and carbon monoxide detectors that were tested and working at time of visit. The lighting and lamps are sufficient for the use of the facility and for residents’ comfort and safety. The showers have non-skid mats present. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The indoor pathways are clear of any obstructions. Disinfectants, cleaning solutions and poisons are locked in garage. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard/side yard and patio for residents with plenty of shade. Operational Requirements: The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 6/1/2026. The facility is approved for a capacity of 6 non-ambulatory and has a current Hospice wavier granted for 3. Staff Personnel Records & Training: The facility has two full-time Administrators on staff. Staff records are kept confidential. LPA reviewed 2 staff files for required forms and signatures, Files had required documents available for review. Files have education/Training for renewal of Administrator Certificates present. One administrator certificate expires on 09/27/26 and another Administrator certificate will expire 3/13/27. Resident Records & Incident Reports: Two files were reviewed for signed and for required documents. All forms were legible and available for review. Updated documents will be provided to LPA. Annual ANS and LIC 602 were done for all residents as of August of 2024. Facility does submit incident reports to the department when required. Resident Rights Information: All require postings were posted in the common area of the facility. CCL Complaint poster and LTCO poster were posted in the entry area of facility. Planned Activities: The facility offers activities to all residents in care. The facility also offers additional activities to include books, magazines, newspapers, television, walks, outside area, and a musician comes. The facility has sufficient space to allow for activities indoors and outdoors. Food Service: The facility handles and prepares food safely. While LPA was at facility breakfast was observed. The meals were fresh, of good quantity and quality, and residents who were at table at time of visit finished all of the breakfast meal. The facility has 2-day perishables and 7-day non-perishables to meet the food service requirement. All food is covered, stored, and marked appropriately. Kitchen areas are kept clean and free from litter and insects. Incidental Medical & Dental: Facility provides transportation to medical and dental appointments when needed. Medication is kept in a locked cupboard in locked garage. LPA reviewed medication records with the Centrally Stored Medication Destruct Record and Medication Administrator Record. Doctors’ orders were present. Prescription and PRN Medications labels were not altered, and medications were stored in original containers. The facility has a locked box for any refrigerated medications. Disaster Preparedness: The current emergency disaster forms were present/posted. The fire extinguishers were charged and last inspected on 08/20/25. Emergency exits and telephone numbers were posted. The facility has an emergency binder with all required records present. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility does not have delayed egress. The facility has 2 hospice residents in care. Hospice care plans are kept on file and up to date. The facility does not have any current residents on oxygen. The facility has exiting door alarms. Exit interview conducted and copy of report printed for Administrator.