St. Anne's Golden Years Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced one (1) year inspection at this facility. LPA met with Licensee, Administrator and explained the reason for the visit. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: At 10:45a.m. LPA and Administrator conducted a physical plant tour of the facility. The facility has one main entrance being used. Required posting are observed to be complete, current and displayed properly. The facility has an approved mitigation and infection control plan on file. The facility is a single-story building and has four (4) bedrooms and three (3) bathrooms located in a residential community. Three (3) bedrooms are double occupancy designated for residents, and one (1) bedroom is designated for staff use. The facility is Fire Cleared for four (4) non-ambulatory residents, one (1) of which maybe bedridden and two (2) ambulatory residents. Hospice waiver for three (3) residents. Smoke detectors and carbon monoxide are hardwired, interconnected and tested for proper function. Fire extinguishers were last purchased on 05/03/2025 and observed fully charged. The most recent disaster drill was conducted on 09/05/2025. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors were inspected. They were found clean and good repair. The facility maintains a comfortable temperature at 73°F. Cont. on LIC 809-C Cont. from LIC 809 Living and dining room furniture were checked. Furniture in the living and dining rooms was observed in good repair, clean and free of hazards. Both areas were appropriately furnished and provided a comfortable environment for residents. Resident rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lit. Residents have sufficient amounts of personal hygiene products which are provided by the licensee. Bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet and shower. The hot water temperature measured at a range of 106.3°F to 118.0°F. Towels and washcloths are not shared. There are enough clean linen available in stock in the linen cabinet located in the hallway. Food Service / Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Food storage and preparation areas are clean. The kitchen appeared clean and the appliances and fixtures functional. Knives and sharps are observed to be kept in the kitchen cabinet locked and inaccessible to residents. Medications: LPA observed medication in the kitchen locked cabinet and inaccessible to residents. First Aid kits are observed to be with complete tools and supplies. Laundry room is located at the side of the facility with no access from inside. The laundry room was observed to be locked and inaccessible to residents. Cleaning agents, toxins and detergents were secured. Garage is detached, locked, and inaccessible to residents. Garage is used as storage for supplies, tools and extra frozen food. Backyard of the facility has outdoor furniture, with a shaded area covered available for residents. The front and backyard passageways were clear of any obstruction. There is no body of water at the facility. Staff records were reviewed. Staff present had criminal record clearances and associated to facility. Staff records appear to be complete and current. Resident records were reviewed. Resident’s records appeared to be complete and current. There is no health and safety issue observed during this visit. Exit interview conducted. A copy of this report issued.the state’s words, verbatim · CDSS document, Sep 17, 2025

Allegation investigated: Facility staff were not meeting residents toileting needs Facility staff did not seek timely medical attention for residents fall Facility staff pushed resident into bed

Licensing Program Analyst (LPA) Antonia Alvizar-Ettima made an initial complaint visit to investigate the above noted allegations. LPA was greeted by Administrator, Licensee and explained the purpose of this visit. At 11:30a.m. a physical plant tour was conducted. As a result of the investigation, LPA found that the resident (R1) in question never resided at this address. LPA reviewed facility residents roster and did not indicate that R1 is a former or current resident at this facility. The information revealed from records supported the information provided by the facility personnel. Therefore, the finding for the complaint allegations is UNFOUNDED. It was determined that the complaint was without a reasonable basis. Therefore, we dismissed the complaint. No health and safety hazard is noted during this visit. Exit interview was conducted and copy of report was issued. Unfoundedthe state’s words, verbatim · CDSS document, Jan 31, 2025 · control 31-AS-20250129161244

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced One (1) Required year inspection at this facility. LPA met with Licensee, Administrator and explained the reason for the visit. A tour of the physical plant was conducted at 10:30a.m. and the following were noted: The facility has one main entrance being used. Required posting are observed to be complete and current and displayed properly. The facility has an approved mitigation and infection control plan on file. The facility is a single story building and has four (4) bedrooms and three (3) bathrooms in a residential street. One (1) bedroom is designated for staff use. The facility is Fire cleared for four (4) non-ambulatory residents, one (1) of which maybe bedridden. Hospice waiver for three (3) residents. All smoke alarms were tested and function properly. The fire extinguisher was last purchased on 05/17/2024. Dual smoke and carbon monoxide are hardwired and interconnected and was tested and functions properly. Fire extinguishers are in the living room, kitchen, office area and observed to be full date of purchased 05/17/2024. Disaster drill was last conducted on 08/23/2024. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were checked. The living room is neat and clean along with the dining room. Furniture were observed to be in good repair and excellent condition. The facility maintains a comfortable temperature at 73°F. Food Service / Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. The kitchen appeared clean and the appliances and fixtures functional. Knives and sharps are observed to be kept in the kitchen cabinet locked and inaccessible to residents. Resident rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lit. Residents have sufficient amounts of personal hygiene product which is provided by the licensee. Bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet and shower. The hot water temperature measured at a range of 112.3°F to 116.0°F. Towels and washcloths are not shared. There is enough clean linen available in stock in the linen cabinet located in the hallway. Medications: LPA observed medication in the kitchen locked cabinet and inaccessible to residents. First aid kit is observed to be with complete tools and supplies. Garage detached to the facility and used to storage for supplies, tools and extra frozen food. Laundry room is located at the side of the facility with no access from inside. Laundry room was observed to be locked and inaccessible to residents. Laundry detergent, cleaning agents and other toxins are observed to be locked and secured in the locked laundry room. Backyard of the facility has outdoor furniture, with a covered shaded area for residents. The front and backyard passageways were clear of any obstruction. There is no body of water at the facility. Staff records were reviewed. Staff present had criminal record clearances and associated to this facility. Staff records appear to be complete and current. Resident records were also reviewed and appeared to be complete and current. There is no health and safety issue observed during this visit. Exit interview conducted. A copy of this report issued.the state’s words, verbatim · CDSS document, Sep 27, 2024