Routine inspection·April 10, 2025

On 04/10/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required 1 year inspection. LPA met with co-administrator Moddie Andaya and explained the purpose of today's visit. Currently there are 6 residents in place and 3 staff in place, one of which is the administrator. The facility is licensed for age range 60 and over. All may be non-ambulatory, of which one may be bedridden. Hospice waiver approved for 2. Bedroom 5 is approved for bedridden. There currently are no hospice and no bedridden residents according to staff. This is a single level facility. Facility temperature is comfortable for residents in care. Facility emergency food supplies such as canned goods are in a large storage closet located in the garage. Additional supplies are in the garage as well. There are 6 resident rooms. Water temperature is tested in the common full bath where residents shower. It was measured at 106F. Water temperature was also tested in room #3 at 106F as well. Cleaning supplies in the kitchen are observed as locked beneath the kitchen sink. Additional cleaning supplies are locked in the garage in a large storage cabinet. Facility knives are observed to be locked in a drawer across from the stove/cooking range. 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. 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 2 fire alarm pull stations, one in the front, and one in the back of the facility. LPA observed 2 fire extinguishers in the facility with inspection tags dated 03/20/2025. Facility conducts emergency drill quarterly. The last drill that was conducted is logged with a date of 02/19/2025. Linens are in place for resident use stored in a hallway closet and in resident rooms. 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, medical kit, are stored in locked medication closet in the main hallway. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. 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 staff and 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 Moddie Andaya is observed as current expiring 11/15/2025. Report is reviewed with Moddie Andaya. A copy of this report is provided to the facility. No citations issued.