Routine inspection·August 24, 2025

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct a required annual visit. Upon arrival, there were two (2) staff and five (5) residents present. The LPA was greeted by the Administrator, Analyn Cervantes and the reason for the visit was explained. Entrance interview conducted. At approximately 9:40 a.m., the LPA along with the Administrator 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 following was observed: Kitchen: The LPA inspected the kitchen/food service area at 09:53 a.m. Knives and sharps were observed locked and inaccessible in a kitchen drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. Common Areas: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. The LPA observed the fire extinguisher to be fully charged with a recharge date of 08/11/2025. Required postings were observed throughout the common space. The LPA observed a fireplace adequately covered at the time of the visit. There is a working telephone on premises. No hazards/obstruction observed inside or out. Report Continued on LIC 809C... Report Continued from LIC 809... Restrooms: There are two (2) restrooms for resident use. Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. Starting at 09:48 a.m., the hot water temperature was measured in both bathroom and they measured within the required range of 105 – 120 degrees Fahrenheit. Bedrooms: There are five (5) bedrooms for resident use. One (1) bedroom is designated as double / shared occupancy, and four (4) bedrooms are designated as private rooms. All resident rooms were observed to be furnished appropriately with linens, appropriate furnishings, and sufficient lighting. The LPA observed a closet with additional clean linens and towels for resident use. Personal hygiene items were observed locked and inaccessible to residents at the time of the visit. No staff bedroom on premises. 24-hour wake staff at all times. Garage: The garage was locked and inaccessible to residents at the time of the visit. The LPA observed an adequate amount of emergency food and water. Washer and dryer were observed inside the garage. Detergents and cleaning supplies were observed in a locked cabinet. A second refrigerator was observed with additional food; properly stored. Backyard: The backyard has a covered patio area with patio furniture for resident use. All passageways were observed to be clear of any obstructions. There is one (1) side gate with latching mechanisms. No bodies of water noted at the time of the visit. Records: The LPA began record review at approximately 10:10 a.m. Five (5) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All files were complete. Report Continued on LIC 809C... Report Continued from LIC 809C... Four (4) personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate yearly training. All files were in order. The current Administrator’s Certificate is valid until 01/08/2027. During today's visit, the LPA conducted interviews with one staff and one resident. No concerns were noted. Infection Control / Emergency Disaster Planning: 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 recently reviewed/updated. Emergency disaster drills conducted quarterly as per regulation; the last one was conducted on 07/09/2025. Medications: Medications review began at approximately 12:50 p.m. The medications are centrally stored in a locked cabinet adjacent to the kitchen. Refrigerated medications were observed in a locked box inside the second refrigerator inaccessible to residents in care. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medication appear to be given as prescribed at the time of the visit. Exit interview conducted. Report was reviewed and a copy was provided.