Routine inspection·September 17, 2024

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an Annual Required 1 Year inspection and met with Administrator Johnny Copero. This facility is licensed for 6 Non-ambulatory residents with a Hospice Waiver approved for 1 of the residents and no Bedridden approval. There were 6 residents and 2 staff on site at the time of inspection. LPA and Administrator toured the facility and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Residents' rooms were furnished per regulation. Water temperature in bathrooms used by residents is within the required range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Closet containing cleaning supplies was locked. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Medications were centrally stored and locked. Facility maintains emergency food and water supplies. Fire extinguishers were fully charged and last serviced May 1, 2024. Smoke and Carbon Monoxide detectors located throughout the facility were tested and operational. Most recent disaster drill was conducted 08/16/2024. Staff have required First Aid and CPR certificates. Johnny "Juanito" Copero filed for renewal of Administrator's Certificate. Required postings were observed. Medication records were reviewed. Continued on 809-C Five staff files and five resident files were reviewed. All were complete. Residents with dementia diagnoses had current Physician's Reports. Files were very well organized. The back yard provides nice areas for residents to sit and watch the birds at the bird feeder. Fencing in the back yard is being repaired/replaced on September 22, 2024. LPA interviewed three residents who stated that they liked the facility and were well-cared for. Licensee/Administrator submitted the following: LIC 500 Personnel Summary- LIC 610 Emergency Disaster Plan Copy of Liability Insurance Administrator to submit photos of new fence upon completion. No deficiencies were found at the time of inspection. No citations were issued