Routine inspection·August 8, 2025

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Mercelo Garcia. During the visit, LPA observed 4 residents and 2 staff. LPA explained the purpose of the visit. (This report is being amended to add additional information.) LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 2 restrooms and residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. While touring the home, LPA noted there was "hook & eye", metal latch outside the living room door, leading towards the outside. Note, this facility is licensed to have 3 non-ambulatory on the first floor and 1 bedridden in bedroom #3. The exit located in the living room, and adjacent to bedroom #3 is the only exit that has a ramp. LPA asked ADM why this latch was on the outside of the door. ADM asked staff S1, who stated the latch was put there because there used to be a resident who wanted to go outside a lot. ADM stated this resident no longer lives in the facility. ADM removed the metal latch during visit. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 70 degrees F, and hot water temperature was measured at 118 degrees F in resident bathrooms. Page 1 Out of 2. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. Residents R1, R2 and R3 did not have multiple medications listed on the centrally stored medication record. Note Resident R1, R2 and R3's centrally stored medication record did not have any medications listed with a fill date of 2025. Fire extinguisher was serviced in November 4, 2024. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. The facility's emergency and disaster plan was last reviewed by ADM on September 21, 2024. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility conducted drills on the following dates: June 15, 2024, September 21, 2024, April 13, 2025, and July 10, 2025. LPA discussed with ADM that drills conducted must occur at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, And Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. LPA Provided ADM with a copy of PIN 25-05-ASC, PIN 25-08-ASC Deficiencies and a technical Assistance is being cited during today's visit. This report was reviewed with Administrator Mercelo Garcia and a copy of the signed report was provided. Appeal rights were provided. Page 2 Out of 2. END OF REPORT.