Routine inspection·June 7, 2024

At approximately 12:40 PM, Licensing Program Analyst (LPA) Stefanie Mutialu made an unannounced annual required inspection of this licensed senior care facility. LPA was greeted by Sharnell Davis, Administrator. The facility is a single story home licensed for four (4) non-ambulatory residents and a hospice waiver capacity of two (2). The facility currently provides care for 4 residents and there are no resident's under hospice care at this time. At approximately 12:50PM, LPA and Administrator 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. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected ,There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins are stored in a locked cabinet in the facility laundry room and kitchen. Sharps and other kitchen supplies that could pose danger if available to residents were found secured in the kitchen cabinet. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. Water temperature measured within regulation between 117 and 120 degrees F at four of four faucets accessible to residents. One out of one fire extinguisher was inspected and charged. Five out of five interconnected combo Smoke/Carbon monoxide detectors were present inspected and found to be in working order. There was enough lighting in all common areas, resident rooms, and hallways. Continued on LIC809-Ca Continued on LIC809 Facility provides art therapist, nutritionist, and activity director paid by facility to ensure clients needs are met. Facility offers a designated activity room in the garage. Medications located in designated cabinet were found to be secured. LPA conducted a spot check of medications and found all administering and records to be in order. Resident was observed interacting with staff in bedroom and living room. Three of four residents were home. One of four residents was at day program. One of four residents was doing artwork and resident's mother was visiting. One of four residents was relaxing in the living room watching television. One of four residents was relaxing in their room. LPA observed staff checking on, engaging, and caring for residents often. At approximately 1:40PM, LPA reviewed Four of four resident records which were all found to be well organized, thorough and contained the required documentation. At approximately 2:15 PM, LPA reviewed six out of eleven staff records which were all found to be well organized, thorough and contained the required documentation. Medication records are thorough and contained physician's orders for each resident. P&I is not commingled. Administrator Administrator Certification is current and expires on 03/16/2026. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC 500 Personnel Summary LIC 400 Cash Affidavit LIC 9020 Register of Facility Client’s/Resident's Liability Insurance Surety Bond No citations issued during today’s visit .