Post-licensing visit·July 1, 2025

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct a post-licensing visit today. Upon arrival, the LPA met with facility staff who contacted Administrator, Sara Jackson and at this time the reason for the visit was explained. The Administrator arrived at the facility at approximately 09:50 AM. Beginning at 09:55 AM, the LPA along with Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN : The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. The LPA observed knives and sharps in a locked drawer at the time of the visit. Refrigerator and pantry were checked for expirations dates; dates were clearly marked. COMMON AREAS : This includes the living room, hallway, and dining area. The LPA observed the living room to be clean and properly furnished at the time of the visit. The dining area was observed to be equipped with adequate seating for resident use. All furniture throughout the facility was observed to be clean and in good repair. The LPA observed a new fire extinguisher with a purchase date of 08/04/2024. All exits in the facility were observed to contain functioning auditory alarms. The LPA observed a working telephone on premises. No tripping hazards were observed inside or out. Report Continued on LIC 809C... Report Continued from LIC 809... BEDROOMS : There are five (5) bedrooms in the facility for resident use; four (4) are designated for single occupancy, and one (1) is designated for shared / double occupancy. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Additional clean linens and towel were observed in a storage closet by the hallway. The LPA observed personal hygiene items locked and inaccessible to residents in care at the time of the visit. Staff room observed on premises. BATHROOMS : There are two (2) bathrooms at the facility. One (1) is designated as a private resident bathroom, and one (1) is designated as a shared/common resident bathroom. All resident bathrooms were observed to be clean and were equipped with nonskid surfaces. Grab bars were observed near resident toilets and were properly secured. Beginning at 10:00 AM, the water temperature was measured in resident bathrooms, and they measured within the required range of 105 and 120 degrees Fahrenheit. OUTDOOR SPACE: The LPA observed an adequate shaded seating area with appropriate outdoor furniture for resident use. The facility has one (1) self-latching gate for emergency use. All passageways were observed to be clear of any obstructions. No bodies of water noted at the time of the visit. GARAGE: The garage is attached to the house. Washer and dryer were observed inside. Laundry detergents and cleaning supplies were observed inaccessible to residents at the time of the visit. The LPA observed an adequate amount of emergency food and water at the time of the visit. RECORD REVIEW: Record review began at 10:20 AM. Five (5) resident files were reviewed for but not limited to; signed admissions agreement, medical assessment, negative tb test results, consent for treatment form, pre-appraisal, appraisal, needs & service plan, and personal rights. All records were complete. Three (3) staff files were reviewed for but not limited to; personnel record, health screening with negative tb test result, fingerprint clearance, first aid / cpr certification, and annual staff training. All files were in order. Administrator Certificate valid until 07/26/2025. Renewal has been started and training is in progress. The LPA conducted interviews with one (1) staff and one (1) resident during today's visit and no concerns were noted. Report Continued on LIC 809C... Report Continued from LIC 809C... MEDICATION REVIEW: Medication review began at approximately 12:00 PM. Medications are centrally stored and kept locked in a file cabinet adjacent to the kitchen. Medications for two (2) residents were observed. Medications appear to be given as prescribed at the time of the visit. EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed facility's emergency disaster plan. The facility’s emergency disaster plan is up to date and is adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 04/14/2025. Next emergency disaster drill is scheduled for mid July. Exit interview conducted. Report was reviewed and copy provided.