The facility’s fire clearance is approved for six (6) residents age 60 and over, including up to six (6) non-ambulatory residents, of whom one (1) may be bedridden. The facility also holds a hospice waiver for six (6) residents.

At the time of inspection, four (4) residents were under hospice care.

Facility Tour & Observations

Personal Rights postings (LIC 613C and Ombudsman), Complaint Poster (PUB 475), and nondiscrimination notice were observed in a common area. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present.

Required “Oxygen in Use” signage was posted in visible locations throughout the facility in accordance with safety requirements.

Physical Plant

The facility is in a residential neighborhood and is a single-story home consisting of four (4) resident bedrooms, three (3) bathrooms (one of which is a private shared bathroom), a living room, kitchen, dining area/tv room, a caregiver corridor and restroom located prior to entering the attached garage, front yard, and backyard. All bedrooms observed contained the required furnishings, including a bed, mattress, linens, dresser, chair, and adequate lighting. LPA observed that cleaning supplies and other toxic substances were accessible to residents and located under the kitchen sink without a lock. During LPA’s visit, the administrator secured the cleaning supplies and toxic substances in a locked cabinet located in the kitchen.

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• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

Extra linens and towels were available and stored in hallway cabinets. Smoke and carbon monoxide detectors were tested and found to be operational. A fire extinguisher was observed near the dining room area . No bodies of water were present on the premises. The backyard contained shaded seating for residents. Passageways and exits were observed to be clear and unobstructed.

Fire Clearance

Based on record review, the Licensee did not comply with the section cited above, as the Licensee did not adhere to the approved fire clearance permitting one (1) bedridden resident; however, the facility had two (2) bedridden residents. An immediate civil penalty of $500.00 will be issued.

An additional refrigerator containing food was observed in the garage. Refrigerators and freezers were maintained at proper temperatures (refrigerators at a maximum of 40°F and freezers at 0°F) and contained a sufficient supply of food, including at least two (2) days of perishable food and seven (7) days of non-perishable food. Fresh produce, proteins, and dry goods were stocked. LPA observed that kitchen knives were accessible to six (6) out of six (6) residents in care due to being stored in an unlocked kitchen drawer. During the visit, the Licensee/Administrator corrected the issue by securing the knives in a locked location.

Health-Related Services & Records

Six (6) resident files were reviewed. While the files contained current required documentation including Admission Agreements, signed consents, Needs and Service Plans, Physician’s Reports documenting TB results and ambulatory status, and Resident Rights acknowledgments, LPA observed that Resident 2 (R2) and Resident 5 (R5) were missing required TB test.

Three (3) residents’ medications were reviewed. Medications were observed to be centrally stored in a locked closet located by the dining room area.

Disaster Preparedness

Last fire/earthquake drill was conducted on September 2, 2025, with logs available. LIC 610D Emergency Disaster Plan was available and updated. Emergency supplies (water, food, flashlights, batteries, first aid) were observed. Infection Control Plan was updated.

(continued on 809C)

Four (4) staff files were reviewed and included criminal record clearances, CPR/First Aid, required training and TB screenings. Administrator Certificate for Xiomara Valencia was valid through February 25, 2027.

Insurance

Liability insurance was in compliance with an expiration date of May 05, 2026.

An exit interview was conducted with the Administrator Xiomara Valencia. During the inspection, deficiencies were observed and cited on the attached LIC 809D/809C in accordance with Title 22, Division 6 regulations. A copy of this report, LIC 809D/809C, and appeal rights will be provided.