Routine inspection·January 23, 2025

On 1/23/2025 at 1:10 PM Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct an Annual Inspection. The facility is a single story building with 6 bedrooms and granted fire clearance approved for 2 ambulatory and 4 non-ambulatory residents. The facility has a hospice waiver for 2. There are currently zero (0) residents at the facility. The facility has not had any residents since the license was granted. At 1:30 PM, LPA conducted a tour and inspection of the indoor and outdoor portions of the facility with Administrator/Licensee, Valjoseph Zamora. Facility was found to be clean and at a comfortable temperature with bedroom doors free from obstruction. Smoke detectors and carbon monoxide detectors were tested in common areas and client bedrooms all of which were found to be in working order. Emergency exits along the one side of the facility have appropriate hardware and found to be unobstructed. Water was measured at 126.6 degrees F in faucets used by residents which does not fall within regulation between 105 & 120 degrees F. Licensee agrees to ensure compliance and submit a water record log for correction prior to accepting any residents or by DOB 2/23/2025. A Technical Violation (TV) was issued for the hot water not being in compliance. There was an ample supply of linens with appropriate bedding equipped in client rooms. An additional supply of hygiene, continence and paper products are located in a secured cabinet in hallway. Stairs and hallways are equipped with several night lights for accessibility and client bedrooms have appropriate furnishings. There is a sufficient amount of dishes and cooking supplies for client use with sharps and other hazardous items kept secured in designated drawer and under the kitchen sink. Cleaning products and other toxins and chemicals are kept out of client access and found secured in the garage and laundry room cabinets and under kitchen sinks. Continued on 809-C... ...Continued from 809 LPA observed adequate supply of both perishable and non-perishable food sufficient for future residents in care. The facility will be conducting weekly grocery replenishment with consideration to client preferences and dietary restrictions. A sample menu is also located on the refrigerator and indicates a healthy and balance set of meals for residents in care. LPA conducted a review of two (2) staff files and found all staff files reviewed to have 1st Aid & CPR certification and annual training on file. LPA observed during file review and Inspection that the facility does not have current liability Insurance. A TV was issued for not having current liability Insurance. The backyard features a large yard and deck with seating for client outdoor use. Windows, screens and blinds are all found to be in good repair. There is a working telephone and internet device available for resident use. Emergency evacuation maps and clear exit signs are observed posted at each exit door. Administrator, Valjoseph Zamora Administrator Certification 7027878740 is current through 3/17/2026. Administrator, Nataly Zamora Administrator Certification 7027958740 is pending renewal. Application received on 5/24/2024. The Following Items are to be submitted to CCLD by DOB 2/23/2025: LIC 308 Designation of Facility Responsibility LIC 610E Emergency & Disaster Plan LIC 500 Personnel Report Proof of Liability Insurance Hot water record log No deficiencies cited during today's visit. Exit interview conducted. Copy of report and LIC9102 (Technical Violations/Advisories) discussed and provided to Administrator. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents