Routine inspection·May 27, 2025

At approximately 9:15 AM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Administrator Nikiyah Jones. Facility is a Residential Care Facility for the Elderly (RCFE) with three (3) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for one (1), with one (1) Hospice residents currently in care. Facility is approved for three (3) non-ambulatory and one (1) bedridden residents. At approximately 9:40 AM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 8/24 and 3/25. Smoke and Carbon Monoxide detectors are hardwired and serviced by the local Fire Marshall. Water temperatures measured 115.7 and 114.8 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Laundry room and cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered. There is a shaded seating area in the backyard with outdoor space for activities. Facility is also equipped with an activities room that is supplied with various materials for arts and crafts. Facility telephone was observed operational during inspection. Continued 809C... Continued from 809... Facility conducts quarterly disaster drills, and the most recent drill was conducted 4/25. LPA observed facility's infection control plan and emergency disaster plan. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 10:30 AM LPA conducted review of three (3) staff records. All required documentation present. At approximately 11:00 AM LPA conducted a review of three (3) resident records. All required documentation present. At approximately 11:15 AM LPA and Caregiver conducted a spot check of medication. Medication is centrally stored and locked. Nikiyah Jones Administrator Certificate 7014445740 expires 1/15/2026. All fees are current as of this time. Caregiver Abby Adkins was designated to sign and receive this report. Updated copies of the following documents shall be submitted to CCL within 30 days of this visit : Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC610E - Emergency Disaster Plan No deficiencies cited. Exit interview conducted with Caregiver, whose signature on form confirms receipt.