Routine inspection·September 22, 2025

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 10:46AM. The LPA met with the Licensee Maria Ayala and informed them of the reason for the visit. Entrance interview conducted. Beginning at 11:14AM, the LPA and Licensee toured the physical plant areas inside and outside to ensure there were no health and safety hazards, and the facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: Kitchen appliances were clean and in operable condition. The facility had a supply of perishable and non-perishable food. Food in the refrigerator and freezer were observed to be properly stored with labels and dates. COMMON AREAS: There was a locked laundry room that connected to the kitchen. The laundry machines were in good condition and had locked cabinets that contained general supplies. There was a garage that remained secure and contained emergency food and water, files, cleaning supplies, and a refrigerator/freezer with extra food. At the time of the visit, the living room and dining room furniture were observed to be in good condition. The living room had a fireplace that was inoperable and screened. Required postings were observed in the entryway walls. A locked hallway closet contained kitchen knives and medications. The facility maintained a comfortable temperature throughout the visit. Nightlights were observed throughout the facility. Report Continued on LIC 809-C BEDROOMS/RESTROOMS: There were six (6) total bedrooms, each private. Bedrooms #1, #3, and #5 had a direct exit to the outside and Bedroom #3 was approved for one (1) Bedridden resident. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens were stored in the hallway closet. There were three (3) total restrooms in the facility: two (2) shared restrooms and one (1) private resident restroom. Restrooms were clean, sanitary, and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap, paper products, and displayed hand washing signs. Hot water was tested and measured at 116.4 degrees F, which is within the required range per regulation. OUTDOOR AREA: The surrounding grounds had a shaded patio area equipped with furniture in good condition for residents and visitor use. The rear also had outdoor activities for resident use. There was one (1) shed that remained locked and contained general storage. There were two (2) emergency exits located on the sides of the facility that were self-latching. All exits and passageways were free of obstruction. RECORDS: Record review began at 11:51AM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and 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 records were in order. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and reviewed annually as required. Emergency disaster drills are conducted quarterly, with the last documented drill on 09/05/2025. Smoke and carbon monoxide detectors were tested at 1:01PM and were operational. Fire extinguishers were observed and were purchased on 08/01/2025. Report Continued on LIC 809-C MEDICATIONS: Medication review began at 2:00PM. Medications were centrally stored and kept inaccessible. Medications were observed for two (2) residents. Medications were labeled and checked for expiration dates and were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.