Routine inspection·January 27, 2024

Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a require 1-year inspection utilizing the full CARE tool. LPA met with Administrator, MaryJane Miranda, and explained the purpose of the visit. Today's census is three residents in care with one resident on hospice services. Facility is licensed for six residents, hospice waiver of two. LPA observed each resident in their private rooms. LPA and Administrator conducted a tour of the interior and exterior of the facility. Areas toured included but not limited to: residents bedrooms, bathroom, kitchen, backyard, staff room/laundry room, and the common areas. LPA observed fire extinguisher to be serviced on 02/27/2023. LPA reminded Administrator to serviced the extinguisher annually to ensure it is in working condition. LPA observed facility to have the required poster of Long Term Care Ombudsman and Community Care Licensing posted in a conspicuous space. LPA observed Administrator Certificate to be current with expiration date of 01/28/2025. LPA observed facility to have 2+ days of perishable and 7+ days of nonperishable foods. LPA conducted a file review of R1, R2, R3, S1 and S2. LPA observed no annual training present for S1 and S2's file. LPA is requesting a copy of LIC 308 and LIC 500 to be submitted to LPA Yang via email by February 2, 2024. LPA obtained a copy of liability insurance. During today's visit, LPA completed the care inspection tool and deficiency was observed. Please see LIC809-D. Exit interview conducted, a copy of the report and appeal rights was provided.