Routine inspection·November 28, 2023

Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit at 2:45 p.m. When the LPA arrived, there was two staff and six residents present. The LPA was greeted by Caregiver Emma Cacho and informed them of the reason for the visit. Administrator Karthiga Vijayakumar shortly arrived. At 02:54 p.m. the LPA conducted a tour of the physical plant with the Administrator. The following was noted: Facility is a single-story residence that consists of six (6) resident bedrooms and three (3) bathrooms. There is one (1) additional bedroom for staff use. LPA observed (1) fully charged fire extinguisher purchased in March of 2023. All smoke alarms and carbon monoxide detectors were tested and functioned properly during the time of visit. The LPA observed all required postings in the hallway. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. Kitchen : The kitchen appeared clean and the appliances and fixtures functional. The LPA observed a sufficient amount of perishable and non-perishable food at the facility; Sharp objects are stored in a locked cabinet. Bedrooms: The resident bedrooms were properly furnished with at least one chair, nightstand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Bathrooms: LPA observed all bathrooms clean, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats in all bathrooms. Residents have sufficient amounts of supplies for personal hygiene. The hot water was measured in the communal bathroom during physical plant tour. Hot water measured 105.6 degrees Fahrenheit, within the required limit of 105-120 degrees Fahrenheit. Report will continue on LIC809-C. Common Areas: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. There is a fireplace in the living room, which is covered with a screen. The facility maintained a comfortable temperature of 76 degrees. Garage/Laundry room: The facility has a laundry room where the washer and dryer are held. The laundry room leads to the garage where cleaning supplies and disinfectants are kept, and additional PPE supplies are stored. The Garage remains locked and inaccessible to the residents in care. Surrounding Grounds (Outdoors) : There was a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises. I nterviews: During the facility tour the LPA conducted two (2) resident Interviews. At 3:23 p.m. the LPA conducted two (2) staff interviews. No immediate concerns were voiced. Due to time constraints the LPA will return to complete annual at a later date. Copy of Licensing Report provided to Administrator.