Routine inspection·March 13, 2025

Licensing Program Analysts (LPAs) Emily Peraldi and Angela Barutyan arrived at the facility unannounced to conduct a required annual visit. At 10:43 a.m., the LPAs met with staff and explained the reason for it visit. At 11:17 a.m., the house manager, Maria Partida arrived at the facility. At 11:05 a.m., the LPAs, along with staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards. KITCHEN: The LPAs observed the kitchen and dining area. Knives are stored locked and inaccessible in a container under kitchen sink. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 11:06 a.m., hot water measured at 105.5-degree Fahrenheit. BEDROOMS: The facility is a single-story residential home with five (5) bedrooms and three (3) bathrooms. The LPAs observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. Hot water measured within required range. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. Continued on LIC-809-C. OUTDOOR SPACE: At 11:20 a.m., the LPAs observed the back patio which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. The garage is attached and remains inaccessible to residents. Laundry units are located inside the garage. Cleaning solutions are located inside the garage. Additional food supplies and water are also stored in the garage. There are no bodies of water on the premises. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and purchased on 02/17/2025. At 11:19 a.m., fire alarms/carbon monoxide detectors were tested and functioned properly. Night lights were present in the hallways and passages. All exits have functioning auditory devices and were operational at the time of the visit. Medications are located in a locked hallway closet. There is a working telephone on premises. The LPAs observed additional clean linens and towels in the hallway closets. RECORD REVIEW: Starting at 11:25 a.m., the LPAs conducted a file review for all residents and staff regularly scheduled and observed the following: Staff have current first aid and training documentation showing required training completed. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All files were in order. Administrator’s Certificate is valid until 03/29/2026. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPAs reviewed the facility’s infection control plan. The facility’s policies and procedures as it pertains to infection control are adequate. The LPAs also reviewed the facility's emergency disaster plan, which was observed to be complete and updated. The LPAs spoke with the house manager to update the facility sketch to reflect the staff room being utilized as storage. The LPAs also spoke with the house manager regarding quarterly emergency drills as the last one was conducted on 10/14/2024. The house manager stated that they will schedule a drill soon. At 12:12 p.m., the LPAs conducted a review of medication and medication documentation with the house manager for three (3) residents and observed no errors. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.