Routine inspection·January 14, 2025

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct a required annual visit today. Upon arrival, there were two (2) staff and five (5) residents present. The staff contacted the Administrator via telephone and explained the reason for the visit. The Administrator, Susan Lumbres arrived at 10:35am. Entrance interview conducted. Starting at 10:40am, the LPA along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of non-perishable and perishable food; properly stored. Refrigerator and dry food pantry were checked for proper labels and expiration dates. The LPA observed knives and sharps in a locked drawer. Cleaning supplies were observed locked an inaccessible at the time of the visit. At 11:06am, the kitchen sink was measured for hot water temperature, and it measured 113.8 degrees Fahrenheit. BEDROOMS : There are four (4) bedrooms for resident use. Two (2) bedrooms are designated as double occupancy; and two (2) bedrooms are designated as single occupancy. The LPA observed all resident bedrooms to be properly furnished and with sufficient lighting. Additional clean linens and towels for resident use were observed in the hallway closet. Report Continued on LIC 809C... Report Continued from LIC 809... BATHROOMS : There are two (2) bathrooms for resident use. Bathrooms were observed to be equipped with nonskid surfaces and grab bars. The LPA observed bathrooms to be properly supplied and had functional fixtures. Starting at 10:40am., the water temperature was measured in bathrooms, and they measured within the required range of 105 and 120 degrees Fahrenheit. COMMON AREAS : The LPA observed the living room and dining room area to be furnished appropriately and all furniture was observed to be in good condition at the time of the visit. The facility maintained a comfortable temperature. The LPA observed required postings throughout the common space. Activities for residents were observed in the living room. There is a working telephone on premises. Fireplace was observed adequately covered. Facility has an adequate amount of emergency food and water. At 11:09am, smoke detector(s) and carbon monoxide detector were tested and were operational at the time of the visit. No obstructions or hazards were observed inside or out. BACKYARD / OUTDOOR: There is a shaded area in the backyard with appropriate furniture for resident use. The exterior passageways were clean and clear of any obstructions in case of an emergency. The LPA observed one (1) gate that was latched. No bodies of water noted at the time of the visit. RECORD REVIEW: The LPA reviewed five (5) Resident Records and four (4) Personnel Records starting at 11:13am. Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, consent for treatment form, and current needs and services plan. All files were complete. Personnel files were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR certifications, and yearly training. All records were in order. Report Continued on LIC 809C... Report Continued from LIC 809C... During today’s visit, the LPA conducted interviews with one (1) resident and one (1) staff. No concerns were noted. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Fire extinguisher was observed to be fully charged. Emergency disaster drills are conducted quarterly, with the last one conducted on 01/10/2024. MEDICATION REVIEW: The LPA conducted a medication review at approximately 1:30pm. Medications are centrally stored in locked file cabinets by the living room. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. The LPA observed PRN authorization letters for all residents on file. Medications appeared to be given as prescribed at the time of the visit. No citations issued. Exit interview conducted. Report was reviewed and a copy was provided.