Routine inspection·June 6, 2025

On 06/06/2025 at approximately 09:35AM, Licensing Program Analyst (LPA) Ali Deniz arrived unannounced to conduct 1-Year Required visit of this licensed Residential Care Facility for The Elderly (RCFE). LPA was greeted by administrator Bernadette Fabricante. Facility has an approved fire clearance and capacity for 6 non-ambulatory residents. The facility currently approved for capacity of 6 residents. Facility has an approved hospice waiver for 3 individuals. Upon arrival, LPA was informed that there were 4 residents in care and 2 staff members on-site. Facility is a 1 story building with 5 Resident bedrooms, 2 bathrooms, and common spaces. At approximately 10:20AM, LPA and Licensee toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Staff were in the process of preparing breakfast in the kitchen at the time of this inspection. Water temperature measured 107.6 degrees F and 113.2 F which is within regulation between 105- and 120-degrees F at faucets accessible to residents. Bathrooms have required non-skid surfaces and grab bars. Cleaning products and knives are stored in a locked cabinets in the kitchen. There is adequate space and furniture on the patio for outdoor activities. Fireplace is observed with a screen. Continued on LIC809-C… Continued from LIC809… Fire extinguishers inspected and charged on 06/21/2024. Carbon Monoxide and smoke detectors were present and in order. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure in a cabinet in the dining room. At approximately 10: 50AM, LPA reviewed 3 resident records and found 3 of 3 residents have current care plans, signed admission agreements, and physician's orders report on file. Medication records are thorough and contained physician's orders for each resident. At approximately 11:05PM, LPA reviewed 3 staff records. 3 of 3 records did contain documentation of completed training records as required. Evidence of current first aid and CPR training were current. LPA was presented with proof of current CPR & 1 st Aid certification for all staff. Administrator Certificate is for Bernadette Fabricante #7002274740 expires 09/26/2025. LPA reviewed the facility emergency disaster plan. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducted and documented a disaster drill on 05/27/2025. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by due date of 06/16/2025: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan Copy/Proof of Updated Certificate of Liability Insurance No deficiencies were observed in the areas inspected, No citations were issued during today’s visit. Exit interview conducted. Copy of report provided to Licensee. Signature on form confirms receipt of documents.