Routine inspection·April 2, 2025

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit. LPA arrived at 09:45 A.M. and met with caregiver, Leonilo Dela Cruz. Caregiver contacted the Administrators by phone. At 10:10 A.M. Administrator, Michelle Racan arrived at the facility with Licensee Representative Janette Villapando. Entrance interview conducted. At 10:17 A.M. LPA conducted a physical plant tour inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. Fire extinguishers are fully charged and last serviced 2/15/2025. The smoke detectors and carbon monoxide detectors are combined units; at 10:40 A.M they were tested and functioned properly. The facility has a fire door in the hallway which also functioned properly. No fire clearance concerns were observed. LPA inspected facility for Fire Safety, Personal Accommodations and Services, Medication Procedures, and Food Service. The following was noted: Bedrooms: There are 6 (six) total bedrooms in the facility; 4 (four) are designated for private resident use and 1 (one) is a shared room. All resident bedrooms were inspected and contained appropriate furnishings and linens. The facility also contains a staff room, which was observed to be locked. Continued on LIC 809-C Continued from LIC 809 Bathrooms: The facility contains 3 (three) full bathrooms; 1 (one) is located in the hallway and is designated for shared use, 1 (one) is a private resident restroom, and 1 (one) is designated for staff and resident use. LPA observed all 3 (three) bathrooms were clean, properly supplied and had functional fixtures. LPA observed all bathrooms to have slip resistant mats and grab bars. Between 10:32 A.M. and 10:45 A.M. hot water was measured in all 3 (three) bathrooms and measured within the required range. Common Areas : These included the dining area and living room. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. There is a designated telephone available for resident use. There are nightlights in all common hallways/rooms providing ample lighting to common bathrooms. A fireplace, which was properly screened, was observed in the living room. LPA observed all required postings on the wall in the main hallway/entryway. Additionally, LPA observed a complete first aid kit, PPE supplies such as gloves and mask and extra linens inside hallway cabinets. The facility maintained a comfortable temperature of 73 degrees. All facility exit doors contain functional audible alarms. Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of non-perishable food at the facility; properly stored. Knives and sharp objects are stored locked under the sink in a locked cabinet. At 10:53 A.M. hot water measured 111.8 degrees Fahrenheit. Resident files and staff files were observed to be stored inside locked kitchen cabinets. The facility has a sufficient supply of perishable and non-perishable food and water. LPA conducted a review of expiration dates on product labels. Laundry Room: There is a locked laundry room; chemicals and cleaning supplies were observed in a locked cabinet inside the laundry room above the washer and dryer. Continued on LIC 809-C Continued from LIC 809-C Surrounding Grounds (Outdoors) : There was a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises. All passageways and exits were observed to be clear and free of hazards. Facility has two total side gates; both were observed to be self-closing and self-latching with clear passageways for emergency exit use. Facility provides sufficient space to accommodate both indoor and outdoor activities. Garage: The facility garage is attached to the home; however, it has a separate locked entry, and it remains locked and inaccessible to the residents in care. Garage was observed to contain emergency water and food supply, an extra fridge, as well as ample storage areas. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly, with the last drill documented on 01/24/2025. RECORD REVIEW: Between 11:23 A.M. and 12:57 P.M. LPA conducted a file review of resident and staff records. All resident files were complete. During audit of staff files, LPA observed three (3) out of five (5) records reviewed to have incomplete Personnel Record (LIC501) form on file. Administrator was able to produce missing forms during today’s visit. Technical Violation issued (TV). MEDICATION REVIEW: Medications are securely stored in a locked cabinet located in the kitchen. At 2:20 P.M. LPA reviewed medications for five (5) residents. All medications observed were labeled, stored, and properly documented at the time of the visit. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and liability insurance. No deficiencies cited. Exit interview conducted. A copy of the report was provided.