Routine inspection·August 7, 2025

08/07/2025, Licensing Program Analyst (LPA) Loera conducted an unannounced Annual Required – 1 yr. inspection visit for this facility. Facility has an emergency disaster plan as required. Facility has an infection control plan as required. There are currently 5 residents in care. Facility approved/cleared for 6 non-ambulatory. Facility has a hospice waiver for 2. LPA was greeted by staff member. Administrator, Helen Rabago arrived shortly after. LPA and administrator toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed a 2 day supply of perishable and 7 day supply of non-perishable food. Refrigerated food was found to be stored in a safe manner. LPA observed residents interacting along with a workout video. Administrator stated they have other activities available for residents such as board games, coloring, and drawing. All rooms were furnished per regulation. All rooms were in good repair. Extra hygiene products and linens were available. Water temperature in sinks accessible to residents in care were measured at 111.9 and 107.6 degrees F which is within the range of 105 to 120 degrees F. Fire extinguishers were last inspected 01/2025. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Sharps are located in the kitchen and were found to be secured. Chemicals were found to be secured. Medications were found to be centrally stored. LPA conducted spot medication count and found all prescription medication to be properly recorded on the Centrally Stored Medication Record. Facilities last fire/emergency drill was conducted 05/19/2025. continued on LIC809C LPA conducted a review of 5 resident records. All records had the required documentation. However, LPA observed residents R1 and R2 to not have a needs and service plan on file. Administrator ensured LPA they will have R1s and R2s needs and service plan completed and on file. LPA observed R2 to not have an updated physicians report on file. Per conversation with administrator, they have been having trouble getting R2s physician report to be completed and filled out by R2s physician. Administrator will reach out to physician to get form completed. LPA observed a hoyer lift that is used for R4. Administrator to ensure facility gets a doctors order and proof of all staff training for hoyer lift to be used for R4, along updating R4s care plan indicating the use of the hoyer lift. LPA conducted review of 3 staff records/training. Upon a review of staff records, LPA found all staff to have required annual and initial training as well as current 1st Aid & CPR certification on file. No deficiencies cited during today's inspection. Updated copies of the following documents were requested for facility file and are to be submitted to CCL 09/07/2025: LIC500- Personnel Report LIC308- Designation of responsibility Updated Liability Insurance Exit interview conducted with Administrator and a copy of this report was provided.