Routine inspection·July 16, 2025

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 10:30 a.m., the LPA met with staff and explained the reason for it visit. At 10:34 a.m., the Administrator Designee Arnida Obtinalla met with the LPA. RECORD REVIEW: Between 10:40 a.m. and 12:20 p.m., the LPA conducted a file review for all residents and staff regularly scheduled and observed the following: Staff have current first aid and training documentation. 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 05/07/2026. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility’s infection control plan. The facility’s policies and procedures as it pertains to infection control are adequate. The LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and updated. Emergency drills are conducted quarterly, with the last drill documented on 06/01/2025 and 06/02/2025. At 12:21 p.m., the LPA conducted a review of medication and medication documentation with the Administrator Designee for two (2) out of five (5) residents and observed that medications were properly documented. Starting at 1:01 p.m., the LPA, along with Administrator Designee toured the physical plant areas inside and outside to ensure there are no health and safety hazards. Continued on LIC-809-C. KITCHEN: The LPA observed the kitchen and dining area. Knives are stored in a locked kitchen cabinet. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 1:03 p.m., hot water measured at 107.9-degree Fahrenheit. Medications are located in a locked kitchen cabinet. Cleaning supplies are located in a locked cabinet under the kitchen sink. OUTDOOR SPACE: At 1:08 p.m., the LPA 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. 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 last serviced on 12/04/2024. At 1:18 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. All exits have functioning auditory devices and were operational at the time of the visit. There is a working telephone on premises. The LPA observed a closet in the hallway with additional bedsheets. The garage is attached and remains inaccessible to residents. Additional cleaning solutions and food supplies are located inside the garage. Laundry units are located near the kitchen area. BEDROOMS: The facility is a single-story residential home with five (5) bedrooms and two (2) bathrooms. Four (4) bedrooms are for resident use and one (1) for staff use. The LPA 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. At 1:15 p.m., hot water measured at 107.0-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. During the time of the visit, the LPA spoke with all five (5) residents. No concerns were noted. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.