Routine inspection·October 9, 2025

Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced required Annual Inspection at the above-named facility. LPA was greeted by staff. Administrator Karina Ramirez Vazquez was contacted via telephone and arrived at 10:13AM. LPA explained the purpose of the visit. Entrance interview conducted. At the time of arrival, there were 5 (five) residents in care and 1 (one) caregiver on duty. The facility accepts residents with a dementia diagnosis; has a hospice care waiver for two (2) residents; and a fire clearance for six (6) non-ambulatory residents. Currently there are no residents on hospice residing in the facility. The facility is a one-story home located in a residential area. Beginning at 11:08AM, the LPA along with the Administrator toured the facility inside and outside to ensure resident health and safety and the facility is in compliance with Title 22 regulation. Various smoke alarms and carbon monoxide detectors were tested and functioned properly. The fire extinguisher was purchased 09/16/2024 and appeared fully charged. BEDROOMS: The facility has 4 (four) bedrooms total; 2 (two) are shared resident rooms and 2 (two) are private rooms. All resident bedrooms were observed to be furnished properly. All resident rooms had appropriate bedding. There is an ample supply of linens and towels stored in the cabinets in the hallway. RESTROOMS: The facility has three (3) full bathrooms for resident and staff use. All restrooms contained grab bars and slip-resistant surfaces. Hot water was measured at 109.8 degrees Fahrenheit, which is within the required range. COMMON AREAS: Paint, windows, blinds, and floors are in good repair. The common living and dining areas are clean and properly furnished. A working telephone is present. There is one (1) fireplace in the Report Continued on LIC 809-C residence, which was properly screened at the time of the visit. Chemicals are stored locked under the kitchen sink and in the locked entry closet. KITCHEN: The facility has a sufficient supply of non-perishable food, perishable food and an emergency supply of water is present. Knives are stored in a locked cabinet. Cleaning supplies were observed locked in a cabinet under the sink. The refrigerator/freezer was at the appropriate temperature (40*F and 0*F). OUTDOOR SPACE: Building and grounds are free from hazard. Patio area observed outdoor shaded seating area for resident use. Both outdoor exit gates were observed to be self-closing and self-latching. RECORD REVIEW: Beginning at 12:00PM (resident files) and 01:20PM (staff files), the LPA began file review. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. All 3 (three) staff files and 5 (five) resident files observed were in compliance with regulation. All trainings were observed to be complete. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: The facility does not currently have an infection control plan. LPA discussed the facility's infection control practices with the Administrator and reviewed the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan was observed to be complete and updated annually, as required. Emergency disaster drills are conducted quarterly. MEDICATION REVIEW: Medications for two (2) residents were reviewed. Medications were observed stored in a locked cabinet. All medications reviewed were properly stored and documented on the Centrally Stored Medication and Destruction Record and appeared to be administered as prescribed. INTERVIEWS: LPA interviewed staff and residents. No concerns noted. No citations issued. Exit interview conducted. A copy of today's report was provided.