Routine inspection·July 25, 2023

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility unannounced to conduct a required annual visit at 1:10 p.m. The LPA was greeted by staff and informed them of the reason for the visit. Administrator Mirvat Yacoub arrived shortly thereafter. The LPA and the staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. KITCHEN: The LPA began the inspection in the kitchen/food service area at 1:25 p.m. the kitchen was observed to be clean and sanitary. Knives and cleaning supplies are stored inaccessible. Kitchen appliances were in operable condition. The facility had a sufficient supply of two-day perishable and seven-day nonperishable food. COMMON AREAS : At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature of 74 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The LPA observed fire extinguishers throughout the facility which were last serviced 04/15/2023. LPA observed required postings throughout the common space. There is a laundry room where cleaning supplies and disinfectants are kept locked in cabinets. The garage is attached and locked. The garage keeps emergency food supplies, water and Personal Protection Equipment (PPE). It is additionally used as an office. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. There is a side gate for client use and is single latched. No bodies of water noted and exits are free of obstructions. BEDROOMS: Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are five (5) designated resident bedrooms and two (2) staff rooms. **Continued on LIC 809-C** PAGE 2 RESTROOMS: There are five (5) resident restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature in bathrooms measured between 108.6-111.3 degrees Fahrenheit. RECORD REVIEW: At 2:00 p.m. a review of facility files was initiated. The LPA observed documentation of Infection Control, Disaster prevention, and liability Insurance. The LPA obtained Client Roster, Staff Roster, and Liability Insurance. Residents’ records review began at 2:15 p.m., records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 3:05 p.m.; medications are centrally stored and locked in a mediation cabinet in the dining room; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The LPA obtained the following documents: - LIC500 Personnel Report - LIC9020 Client Roster - Liability Insurance No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.