Routine inspection·March 5, 2025

On 03/05/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced annual inspection visit. LPA met with licensee/Administrator Elena Madriaga. During today's visit there are 4 resident present and 4 staff. LPA was allowed entry into the facility. This is a two story facility. The facility is licensed for ages 60 and over. 5 may be non-ambulatory. Facility is cleared for 3 hospice residents and one bedridden resident. There is 1 hospice resident as of today's inspection. The physical plant was toured inside and outside of the facility to ensure the safety of the residents. LPA observed the facility kitchen which is clean and observed appliances are in good repair. Knives are stored and locked in a lower cabinet in a bright orange tool box. Medications are observed to be locked in a cabinet as well in an area adjacent to the kitchen in between the garage and kitchen. Perishable and non-perishable food items are observed as in place. There is an additional freezer in the garage. Cleaning supplies are observed to be locked. First aid kit is observed as complete with required items. LPA observed that there are multiple fire extinguishers in place last inspected 06/12/2024, smoke detectors, carbon monoxide detectors are observed in place through out the facility, facility smoke detectors are hard wired, and central heating system is functioning. Facility has full sprinkler system through out. Laundry area is also observed as fully operational in the garage. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Exit doors are labeled. Resident bathrooms are observed to be in good working order. Non-skid mats are in place in showers. Water temperature was measured at 118F in a common bathroom in the rear of the facility and at 120F in a resident bathroom. LPA advised on monitoring the water temperature to ensure it does not exceed 120F. Continued on next page... Page 2 LPA observed resident rooms at random and all appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. Resident linen supplies are observed as in place. During today's visit LPA reviewed 4 resident files and 4 staff files of which all are current and includes health screenings for all staff. Facility does not handle resident monies. Resident medications are reviewed and are logged appropriately. Facility allows resident's to use licensee's phone for virtual or remote meeting of family members. Emergency keys are available for staff use. Last disaster drill conducted on 12/28/2024. Administrator certificate is current for Elena expiring 11/10/2026. The following updated forms are requested to be submitted to CCLD by 03/12/2025 : • Copy of updated Administrator Certificates posted in facility. • Copy of facility's liability insurance • LIC308 Designation of responsible staff person • LIC610E Emergency Disaster Plan • LIC500 Staff Schedule • Copy of control of property or current lease No citations are issued on this day. Report is reviewed with licensee/administrator Elena Madriaga.