Routine inspection·June 18, 2025

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit. LPA initially met with facility staff. Administrator Maricar Lee arrived shortly thereafter, then back-up Administrator/Designee Michelle Parr arrived and met with LPA for the remainder of the visit. LPA explained the reason for the visit. Beginning at 02:10PM, LPA and Designee 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 7/30/2024 and appeared fully charged. OUTDOOR SPACE: 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, extra food, and storage. 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. 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. Report Continued on LIC 809-C RESTROOMS: LPA observed 3 (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 slip-resistant surfaces. Water temperature was measured in the shared resident restroom and measured at 116.5 degrees Fahrenheit, which is within the required range. BEDROOMS: LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 5 (five) total bedrooms; 4 (four) are designated for resident use (two shared, two private) and one is designated as a staff room which was locked during the visit. DISASTER PLAN/EVACUATION DRILLS/INFECTION CONTROL: LPA reviewed the facility's disaster plan which was complete and updated annually as required. Evacuation drills are conducted quarterly, with the last documented drill on 05/12/2025. Licensee has an infection control plan, which has been updated for 2025 and the facility has an adequate supply of PPE. MEDICATIONS: LPA reviewed medications for 2 (two) residents. Medications appear to be given as prescribed and documented per regulation. STAFF AND RESIDENT RECORDS: LPA reviewed records for 5 (five) staff and 5 (five) residents. All records reviewed were complete. INTERVIEWS: Throughout the visit, LPA interviewed 2 (two) residents and 2 (two) staff. No concerns were noted. No citations issued. Exit interview conducted and a copy of the report was provided.