Routine inspection·October 21, 2025

Licensing Program Analyst (LPA) Melisa Rankin arrived at 8:52 a.m. to conduct a 1-year required annual visit. LPA met with Jeosela Dizon, Administrator. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: LPA toured resident rooms and observed that rooms were tidy, free of odor, and the lighting and lamps are sufficient for the use of the facility and for resident comfort and safety. Toilet, hand washing and bathing facilities are operational and secure grab bars are present. The showers have non-skid mats/flooring. The indoor pathways are clear of any obstructions. Disinfectant and cleaning solutions are inaccessible to residents in care and locked under kitchen sink. The facility has sufficient space inside and outside for activities and visiting. The facility has telephone and internet service for residents’ use. The facility has smoke and carbon monoxide detectors that were tested and operational. Operational Requirements: The facility has a current plan of operation on file with the department. LPA will review fire clearance within stated records. A staff room noted on the fire clearance is now used as a clients room, the room has a sliding door. The facility is approved for a capacity of 6. The fire clearance is granted for 6 non-ambulatory residents. Hospice waiver is approved for 4 residents. There is currently 1 hospice resident. Personnel Records & Training: The facility currently employs 2 full-time staff, 5 on-call staff, and 1 administrator. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Continued on 809-C Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. Administrator Certificate is active and expires on 4/2/27. The facility keeps confidential files for each staff member. Full time staff have annual training completed for various subjects/topics and hours for 2025. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, Physicians reports, Pre-appraisals, Appraisals Needs and Services Plan, Emergency and ID forms, and all forms were legible. Food Service: The facility has 2-day perishables and 7-day non-perishables to meet the food service requirements. Meals were prepared during LPA visit. All food is covered and stored appropriately. Cleaning solutions and equipment are stored separately from food supplies. Administrator is going to do a thorough review of all food items in the refrigerator and pantry. Lots of fresh fruit and vegetables were available for residents. Incidental Medical Services: Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. The facility uses the Centrally Stored Medication and Destruct Records (CSMDR) and the Medication Administration Records (MAR). LPA reviewed a sampling of residents’ medications, no medications were expired, and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility last conducted a quarterly disaster drill/training in July of 2025. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Exit interview conducted and copy of report printed for Administrator.