Routine inspection·September 18, 2023

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Required - 1 Year inspection and met with, Administrator, Lina Fojas. There are currently 5 residents in care. This facility is licensed for 6 non ambulatory residents, with hospice waiver approved for 3 of the residents and none of the residents are approved for bedridden. LPA toured the home and found the home organized at a comfortable temperature with all exits free from obstruction. This home is a two level home and all the resident bedrooms are located on the first level of the home. Residents have a call button to alert staff and call bell button was tested and operational during inspection. Exit doors have auditory alarms to alert staff. Smoke detectors and carbon monoxide detectors were tested and operational. The fire extinguisher located in the kitchen was observed charged and facility had a proof of purchase receipt attached of 6/19/2023. Fire drill was conducted by the facility and documented on 9/3/2023. Water temperature in the resident bathroom was tested and found to be within appropriate range of 105-120 degrees. Bathrooms have required non-skid surfaces and grab bars. Cleaning products and knives are stored in locked cabinets in the kitchen. There was a 7 day supply of non-perishable foods. There are adequate dishes, glasses and silverware. Residents' medications are stored in kitchen locked cabinet and closet. Resident and staff files are located and locked in closet. LPA reviewed staff files and staff have the required training and proof of CPR/1st aid that expires 2025. Resident files were reviewed and found complete and organized. LPA reviewed medication. Continue report see LIC809-C LPA discussed Emergency Disaster Plan and Infection Control Plan. Licensee/Administrator to submit the current following documents by 10/15/2023: · LIC 308 Designation of Facility Responsibility (Received 9/18/2023) · LIC 500 Personnel Report- (Received 9/18/2023) · LIC 400 Affidavit Regarding Client/Resident Cash Resources · LIC 610E Emergency Disaster Plan (Received 9/18/2023) · LIC 9020 Register of Facility Residents (Received 9/18/2023) Infection Control Plan of Operation (If changes) Copy of Liability Insurance- (Received 9/18/2023) Copy of Administrator Certificate (Received 9/18/2023) No citations issued during todays inspection.