Routine inspection·September 25, 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 four (4) residents present. The LPA was greeted by staff and at this time the reason for the visit was explained. The facility designee, Sara Jackson arrived during the inspection. Entrance interview conducted. At approximately 9:55 a.m., the LPA along with staff 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 approximately 09:55 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. At 10:00 a.m., the hot water temperature in the kitchen faucet was measured at 116.7 degrees Fahrenheit. 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 a fire extinguisher to be recently purchased with a date of 07/07/2025. Required postings were observed throughout the common space. There is a working telephone on premises. Activities were observed in the living room. Auditory alarms were observed functioning during the inspection. Cameras were observed in the common areas. No hazards/obstructions observed inside or out. Report Continued on LIC 809C... Report Continued from LIC 809... Restrooms: There are two (2) restrooms for resident use. The first bathroom is located by the main hallway and the second bathroom is located in bedroom #4. 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 10:09 a.m., the hot water temperature was measured in both bathrooms, and they measured between 113.7 and 117.5 degrees Fahrenheit. Personal hygiene items were observed locked and inaccessible to residents at the time of the inspection. Bedrooms: There are five (5) bedrooms for resident use. Four (4) bedrooms are designated as private / single occupancy, and one (1) bedroom is designated as a double / shared occupancy. Resident rooms were observed to be furnished appropriately with linens, appropriate furnishings, and sufficient lighting. There is a closet with additional clean linens and towels for resident use. The LPA observed a staff bedroom on premises. Garage: The washer and dryer were observed inside the garage. Detergents and cleaning supplies were observed locked and inaccessible during the inspection. The LPA observed an adequate amount of emergency food and water; properly stored. Outdoors: The backyard has a covered patio area with patio furniture adequate for resident use. There is (1) side gate with latching mechanisms. All passageways were observed to be clear of any obstructions. Records: The LPA began record review at approximately 10:25 a.m. Four (4) 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 in order. Report Continued on LIC 809C... Report Continued from LIC 809C... Two (2) personnel files 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 complete. Emergency Disaster Planing: During today’s visit, the LPA 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 07/07/2025. Medications: Medications review began at approximately 12:00 p.m. Medications are centrally stored and kept in a locked file cabinet adjacent to the dining room. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Four out of four resident’s medications were observed and reviewed. Medications are properly documented on the Centrally Stored Medications and Destruction Record (CSMDR) and medications appear to be given as prescribed at the time of the inspection. Exit interview conducted. A copy of report was provided.