Routine inspection·April 23, 2025

On 04/08/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required 1 year inspection. LPA met with administrator Judy Roias and explained the purpose of today's visit. Currently there are 4 residents in place and 3 staff, one of which is the administrator. A new resident is due to move in on this day but is not present during LPAs visit. The facility is licensed for age range 60 and over. All may be non-ambulatory. 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 111F. Cleaning supplies are observed to be locked in the garage. Facility knives are observed to be locked in the medication room. 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. Majority of the canned goods are stored in the garage. The garage has two additional refrigerators with staff and resident food. Laundry area is observed in the garage as well and is fully operational. A tour of the outside of the facility is conducted. Emergency routes are free and clear of any obstructions. At the rear of the facility lot is a separate dwelling that is rented out privately. There is no connecting entrances from the facility to that dwelling. Smoke detectors and carbon monoxide detectors are located through out the facility as well as fire sprinklers. The facility is also equipped with 1 fire alarm pull in the front of the facility. LPA observed 2 fire extinguishers in the facility with inspection tags dated 04/07/2025. Facility conducts emergency drill quarterly. The last drill that was conducted is logged as March 17, 2025. Linens are in place for resident use also stored in the medication room. 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 in locked medication closet near the front of the facility. 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 4 staff files and 4 resident files on this day which appear to be current based on review. Staff training records are observed to be current and in place. Administrator certificate for Judy Roias is observed as current expiring 05/11/2025 The following updated items are to be received by 04/30/2025 : • 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 Michelle Roias. A copy of this report is provided to the facility. No citations issued on this day.