Routine inspection·March 11, 2025

Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual inspection. LPA met with administrator Johnna Udden and explained the reason for the visit. Records : Record review was initiated at 8:30 a.m. Facility records are stored in the locked cabinet inside a locked office. The LPA observed documentation of Infection Control, Disaster prevention, Insurance Liability and last Disaster drill (conducted on 02/08/2025). The LPA reviewed records for five (5) out of six (6) residents, three staff and two administrators. All documents reviewed were complete. Medication : Medications review for three (3) residents began at 09:30 a.m.; medications are centrally stored and locked in a cabinet in the dining room; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. At 09:55 a.m. the LPA and Administrator conducted a physical plant tour inside and outside to ensure there were not health and safety hazards and the facility is in compliance with Title 22 Regulations. The smoke detectors and carbon monoxide were tested and functioned properly. The fire extinguisher appeared fully charged and was recently purchased in February 21, 2025. Common Areas : Common seating area and dining room furniture were observed to be in good condition. Kitchen : Knives are stored in a locked cabinet drawer. Cleaning supplies were stored in a locked cabinet under the sink. Appliances were in operable condition. The facility has enough supply of perishable and non-perishable food. Report will continue on LIC809-C, 2nd page. Bedrooms: There are four bedrooms for residents. Two are shared rooms and two are private. All bedrooms were appropriately furnished, had sufficient lighting and clean linens. Bathrooms : There is one bathroom in the hallway and one bathroom for private use in the shared main bedroom. Bathrooms were clean, shower area was in clean condition with grab bars and a non-skid mat available. Paper towels and soap were available for hand washing. The hot water temperature was tested in the bathrooms and ranged between 110.3*F - 113.5*F. Outdoor Space : Backyard has a covered outdoor area equipped with furniture in good repair for residents’ use. There were no bodies of water noted. Side gate is unlocked and self-latching. Interviews : LPA conducted interviews with three (3) residents and two (2) staff; no concerns noted. No citations were issued. Exit interview was conducted and report was issued to the administrator.