Routine inspection·June 26, 2025

Licensing Program Analyst (LPA) Teresa Camara conducted a required annual inspection at the facility. LPA met with licensee/administrator Halina Garbacz and explained the reason for the visit. LPA, along with the administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The facility's last 5-year fire inspection was completed on 1/6/2023 with no concerns noted. LPA, along with the director of operations Bryant Barron, tested randomly chosen combination smoke/carbon monoxide detectors throughout the facility which all functioned properly during the visit. Fire extinguishers appeared fully charged and were last serviced 4/15/2025.. RESIDENT ROOMS/RESTROOMS: There are twenty-two (22) resident rooms licensed for double occupancy, however most of the rooms are used as single-occupancy at this time. LPA inspected ten (10) resident rooms Rooms contained the appropriate furnishings, linens, and bedding. Half of the resident rooms have full bathrooms that are jack-and-jill style - shared between 2 adjacent rooms. The other resident rooms have half bathrooms (toilet and sink) which are private. The residents in these rooms utilize one of the two shower rooms in the hallway nearby their rooms. Restrooms observed were clean and sanitary and in operating condition with grab bars and non-slip surfaces. Water temperature was tested and measured at 110 degrees Fahrenheit which is within the required range of 105*F-120*F. (continued on LIC809-C) COMMON AREAS/BUILDINGS AND GROUNDS: There is a large TV/Activity room with a screened fireplace, sofas, and tables with chairs. There is a patio area equipped with seating and tables with umbrellas. Some of the residents' rooms have semi-private covered patio areas with seating and tables as well. Cleaning chemicals are stored in the locked janitor's closet. Personal Protective Equipment (PPE) and personal care items are stored in a locked storage closet. There is a locked garage on the property which is used for storage. LPA observed required postings. The Emergency Evacuation Plan was complete. Walkways were free of obstructions. KITCHEN/DINING ROOM: The dining room was properly furnished. The facility has a commercial-style kitchen. Appliances appeared clean and functional. There was a sufficient supply of food (perishable and non-perishable) and water. The facility's menu was posted. STAFF: LPA spoke with three (3) staff; there were no concerns noted. LPA reviewed five (5) staff files and all were complete. Documents reviewed included, but were not limited to, training records, TB test results, health screenings, and fingerprint background clearance. Disaster drills are conducted semi-annually and administrator was advised they must be done quarterly for different types of emergencies. Administrator was given a technical advisory for this deficiency. RESIDENTS: LPA interviewed two residents; no concerns were noted. LPA attempted interviews with two other residents, however due to cognitive decline was not able to complete the interviews. LPA reviewed five residents' files and all were complete. Documents reviewed included, but were not limited to, physician's reports, admission agreements, personal rights, and needs and services plans. MEDICATIONS: LPA reviewed medications which are stored in the locked medication room. The facility utilizes Medication Administration Records (MAR) to ensure medications are given correctly. The facility has Centrally Stored Medication and Destruction Records (CSMDR) which were complete. The medications reviewed appeared to be given as prescribed and the medications were properly labeled. The first aid kit is also stored in the locked medication room. No deficiencies cited. Exit interview conducted. A copy of today's report and appeal rights were provided.