Routine inspection·February 6, 2025

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 9:40 a.m., the LPA met with staff and explained the reason for it visit. At 10:25 a.m., the Administrator, Faver Alexander Miranda arrived at the facility. RECORD REVIEW: Between 10:10 a.m. and 11:08 a.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 showing required training completed. 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 02/23/2025. 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 12/14/2024. At 11:10 a.m., the LPA, along with Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards. BEDROOMS: The facility is a single-story residential home with four (4) bedrooms and two (2) bathrooms. 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 11:22 a.m., hot water measured at 107.5-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. Continued on LIC-809-C. OUTDOOR SPACE: At 11:16 a.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. The garage is attached and remains inaccessible to residents. Laundry units are located inside the garage. Cleaning solutions are located inside the garage/ storage area. There are no bodies of water on the premises. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 11:23 a.m., hot water measured at 105.4-degree Fahrenheit. 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 11/08/2024. At 12:27 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. Night lights were present in the hallways and passages. All exits have functioning auditory devices and were operational at the time of the visit. Medications are located in a locked hallway closet. There is a working telephone on premises. The LPA observed a closet in the hallway with additional clean linens and towels. At 12:28 p.m., the LPA conducted a review of medication and medication documentation with the Administrator for five (5) residents and observed that all medications were properly documented. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.