Routine inspection·April 4, 2025

On 04/04/2025, Licensing Program Analysts (LPAs) Arielle Pascua and Triel Lindstrom arrived unannounced to this facility to conduct an annual visit. LPAs met with Staff members (SM), Nicollete Groves and Sharion Lamison and explained the purpose of the visit. LPAs asked that SM Groves call the Facility Designated Administrator (FDA), Ana Guerrero that CCL was present at this time. Shortly after, LPAs met with FDA Guerrero. Current census was 6. A brief interview with FDA Guerrero was conducted. This facility is licensed to serve and retain 6 elderly residents whom of which all may be non-ambulatory. This facility also has a hospice waiver for 4 residents at this time. LPA Pascua toured the grounds and observed them to be well maintained. All paths were free of obstruction. LPA Pascua toured the physical plant. The facility is a single story building with 4 bedrooms. There are 2 double occupancy rooms and 2 single occupancy rooms. The facility was observed to be sanitary and free of odor. There was adequate furnishings and lighting throughout. The facility maintains an adequate supply of linens. All furniture was observed to be in good repair. LPA Pascua inspected the kitchen and observed all knives to be locked and inaccessible to residents in care. There was in excess of a 2 day supply of perishable food and a 7 day supply of non-perishable food. Food in the refrigerator was labeled with the date opened. There was no expired food product observed. Lunch service was provided during the course of this inspection and residents received different lunches according to each individual's preference. There was fresh fruit and vegetables available. The smoke detectors were also observed to be in good working order. The fire extinguisher was last serviced in on 08/23/2024 and is in compliance. The first aid kit was observed to be complete. LPA Pascua reviewed 3 resident files and 3 staff files all of which were complete and up to date. The administrator has a active administrator certificate #701097840 and expires on 10/29/2025. The medications were observed to be locked and inaccessible to residents in care. The facility monitors and logs the effectiveness of PRN's given. The Medication Administration Record was compared to medication on hand and was consistent. The facility does not handle any Personal and Incidental funds. The following forms to be submitted to department: -LIC 308 -LIC 400 -LIC 500 -LIC 610E The facility is in substantial compliance. No deficiencies were observed. An exit interview was conducted and a copy of this report was provided.