Facility Evaluation Report

At approximately 11:15 AM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a required 1-year annual inspection and was greeted by Mary Ann Ordono, Caregiver/Responsible Party (RP). Licensee was contacted via telephone and gave LPA permission to continue with the inspection with the RP. Facility is a Residential Care Facility for the Elderly (RCFE) with four (4) residents in care. All residents were present during today's inspection. Facility has a hospice waiver for four (4), a bedridden waiver for one (1), and is approved for all non-ambulatory residents, and currently has one (1) hospice resident in care.

At approximately 11:30 AM, LPA initiated a tour of the facility with RP and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens and paper products available to residents. Residents' bedrooms were inspected and observed to have the appropriate furnishings as outlined in Title 22 regulations. Bedroom #6 was noted to have medium pile carpet and smelled of urine with RP agreed and licensee indicating the incontinent resident will be moved to a room with laminate flooring and the room will be thoroughly cleaned. (technical violation issued). A rear staff bathroom was noted to have stained baseboard and previously wet sheetrock and licensee was advised to replace both, in addition the top of the refrigerator and microwave hood require cleaning and a technical violation was issued. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a covered seating area in the enclosed front yard with outdoor space for activities. LPA observed a locked shed in the backyard which LPA inspected and observed the contents which consist of tools, chemicals, and extra facility equipment. LPA observed an activity schedule and was informed that the facility conducts morning exercises at least 4 times per week. LPA observed games, puzzles, and activities for residents in care.

Facility's fire extinguisher was observed charged and was last serviced February 2025. Smoke and Carbon Monoxide detectors were tested and operational during inspection, as well as, no-smoking signs and oxygen in use signs were posted.