Routine inspection·April 24, 2025

On 04/24/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required 1 year inspection. LPA met with caregiver Emely De La Cruz and explained the purpose of today's visit. Later during the visit the administrator Elizabeth Viducich arrived and met with LPA. Currently there are 5 residents in place and 3 staff, one of which is the administrator. The facility is licensed for age range 60 and over. All may be bedridden. The facility has a hospice waiver in place for 4 residents. 2 residents are currently on hospice. This is a single level facility. The facility ambient temperature is comfortable. There are 6 resident rooms. All rooms contain a half bathroom. Water temperature is tested in the common hallway full bathroom measuring as 114F. Cleaning supplies are observed to be locked in a hallway closet. Facility knives are observed to be locked in the hallway closet as well. Kitchen food supplies are observed to be in place with 2 day fresh food supply and canned goods fulfilling the 7 day emergency food supply. Canned goods are stored in a large hallway closet. The garage has three additional refrigerators for resident food. Laundry area is observed in the garage as well and is fully operational. Emergency water is stored in the garage as well. A tour of the outside of the facility is conducted. Emergency routes are free and clear of any obstructions. Smoke detectors and carbon monoxide detectors are located through out the facility. The facility is also equipped with 1 fire alarm pull in the front of the facility next to the front door. LPA observed 2 fire extinguishers in the facility with inspection tags dated 04/15/2025. Facility conducts emergency drill quarterly. The last drill that was conducted is logged as March 2025. Linens are in place for resident use stored in a hallway closet. Continued on next page... Page 2 LPA observed all resident rooms and observed that they contain the required furniture and lighting as outlined in Title 22. Medications, first aid kit, and sharps are stored appropriately. Toilet and bathing facilities are equipped with grab bars and non-skid mats. Hygiene supplies are in place. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed as current. LPA reviewed 3 staff files and 5 resident files on this day which appear to be current based on review. Staff training records are observed to be in place. Training has not been conducted based on file reviews within the last year. Administrator certificate for Elizabeth Viducich is observed as current expiring 08/27/2026. The following updated items are to be received by 05/01/2025 : • Copy of updated administrator certificate • 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 copy of lease Report is reviewed with Elizabeth Viducich. A copy of this report is provided to the facility.