Routine inspection·May 4, 2023

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Required - 1 Year inspection and met with, Administrator, Magdalena Casuga and Aileen Bryant and toured the home. Aileen's Administrator certificate #6045024740 is active and expires 10/4/2023. This facility is licensed for a total of 6 in which 4 of the residents may be non-ambulatory. There is currently 1 resident in the home. Facility does not have approval for bedridden, or Hospice. Resident R1 recently fell while visiting another home, was taken to emergency and received stitches on their head. R1 is doing well and sutures were removed. R1 is in the process of transferring to a sister facility. LPA toured facility and grounds and observed facility was found to be clean at a comfortable temperature, with all exits free from obstruction. Facility has at least two days of perishable and one week of non-perishable foods for the amount of residents living in the home. Fire Extinguisher was found to be charged, and serviced 3/2/2023. Smoke alarms and Carbon monoxide detector are operational. Facility last fire drill was conducted on 3/24/23. Medication is centrally stored and locked in the kitchen pantry. Hot water temperature read 106 degrees F. which is within the required range of 105- 120 degrees f. LPA reviewed resident file, and staff files. and found complete Continue report see LIC809C LPA went over infection control plan. The back yard is fully fenced and no hazards observed. Licensee/Administrator to submit the current following documents by 6/1/2023: · LIC 308 Designation of Facility Responsibility · LIC 500 Personnel Report · LIC 400 Affidavit Regarding Client/Resident Cash Resources · LIC 610E Emergency Disaster Plan · LIC 9020 Register of Facility Residents Infection Control Plan of Operation (If changes) Copy of current Liability Insurance Copy of current Lease Agreement Current facility sketch No Citations issued during this visit.