Routine inspection·June 11, 2024

Licensing Program Analyst (LPA) Teresa Camara arrived at the facility unannounced to conduct a required annual visit. LPA initially met with Administrator Maricar Lee but she had to leave for an appointment. Back-up Administrator/Designee Michelle Parr met with LPA for the remainder of the visit. LPA explained the reason for the visit. LPA and 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 smoke detectors were tested and functioned properly; as did the fire door in the hallway. The carbon monoxide detector was tested and functioned properly. The fire extinguishers were last serviced on 7/17/2023 and appeared fully charged. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room, family room, and dining room furniture was observed to be in good condition. LPA observed the required postings in the common area. The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water. The garage was observed locked and contained the laundry area, cleaning supplies, emergency food and water supply, PPE supply, and storage. KITCHEN : Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. BEDROOMS: LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are five total bedrooms; four are designated for resident use (two shared, two private) and one is designated as a staff room which was locked during the visit. Report Continued on LIC 809-C (continued from LIC 809) RESTROOMS: LPA observed three restrooms in the facility; one is a shared restroom, one is a private restroom and one is the staff restroom. Restrooms were clean, sanitary and in operating condition with grab bars and non-skid surfaces. Water temperature was measured in both resident restrooms and both were within the required range of 105 degrees Fahrenheit to 120 degrees Fahrenheit with a average temperature of 114.1 degrees Fahrenheit. DISASTER PLAN/EVACUATION DRILLS/INFECTION CONTROL: LPA reviewed the facility's disaster plan which was complete. Evacuation drills are conducted quarterly. Licensee has an infection control plan and the facility has an adequate supply of PPE. MEDICATIONS: LPA reviewed medications for two residents. Medications appear to be given as prescribed. STAFF AND RESIDENT RECORDS: LPA reviewed records for five staff and four residents. Records were complete. INTERVIEWS: Due to the residents' medical conditions, LPA was not able to interview them. LPA interviewed two staff; there were no concerns. Exit interview conducted and a copy of the report issued.