Home Away Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) N. Galarza arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation. LPA was greeted and granted entry by Administrator Adriana Kiss. Administrator has a valid administrator's certificate expiring on 5/10/2026. The following was observed during the inspection: The facility is a single story home located in a residential neighborhood consisting of 3 resident bedrooms, 2 staff bedrooms, living room, dining room, kitchen, laundry room, 3 bathrooms, backyard patio area, detached garage, and a building/ ADU (Additional Dwelling Unit) in the rear of the property. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the backyard. Personnel Records/Staff Training: Staff has criminal background clearance and training. Only Licensee/Administrator file was reviewed. Proof of staff training, health clearance, and 1st Aid/CPR training us current. Resident Records/Incident Reports: The facility is not currently caring for any residents. Licensee wishes to remain licensed. RCFE complaint poster and Personal rights were observed posted. No health and safety concerns were observed. No deficiencies were observed. An exit interview was conducted with Administrator Adriana Kiss. A copy of the report was issued.the state’s words, verbatim · CDSS document, Feb 19, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Galarza conducted an unannounced annual inspection visit. The purpose of the visit was explained to Administrator Adriana Kiss. The facility is licensed to care for elderly residents ages 60 and older. The facility is a single story home located in a residential neighborhood consisting of 3 resident bedrooms, 2 staff bedrooms, living room, dining room, kitchen, laundry room, 3 bathrooms, backyard patio area, detached garage, and a building/ ADU (Additional Dwelling Unit) in the rear of the property. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the backyard. Twelve (12) CARE tools domains were reviewed. The following were observed/inspected: Infection Control: The Infection Control Plan was reviewed. The facility has a supply of Personal Protective Equipment (PPEs). Operational Requirements: A Dementia and hospice waiver for 1 resident, and a fire clearance for 6 non-ambulatory residents, of which one (1) may be bedridden in room 1 is in place. Facility does not handle resident P & I monies; therefore a Surety Bond is not in place. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is not active because there has not been any residents since Dec. 2022. Physical Plant/Environment Safety: The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Cleaning supplies and toxic substances are inaccessible to residents. The facility has fully charged fire extinguishers. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. The last Emergency Disaster drill was conducted on 1/2/2025. Staffing: The facility is licensee operated. Licensee is the only staff at this time due to zero census. Personnel Records/Staff Training: Administrator certificate expires 5/10/2026. Staff has criminal background clearance and training. Only Licensee/Administrator file was reviewed. Proof of staff training, health clearance, and 1st Aid/CPR training us current. Resident Records/Incident Reports: The facility currently is not caring for any residents. Licensee wishes to remain licensed. RCFE complaint poster and Personal rights were observed posted. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Incident Medical and Dental: Not applicable due to zero census. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. Facility has a First Aid Kit and Manual. Residents with Special Health Needs: There are currently no residents residing at the facility. A Technical Advisory was issued advising that an updated facility sketch shall be submitted to reflect the rear ADU. No health and safety concerns were observed. No deficiencies were observed. An exit interview was conducted with Administrator Adriana Kiss. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jan 31, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to staff Zoltan Kiss. Administrator Adriana Kiss arrived shortly after. There are currently zero (0) 4 elderly residents in care. Twelve 12 (CARE) tool domains were utilized during the inspection. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. Staff are no longer wearing masks or screening visitors. A visitor sign-in station is still in place. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. Operational Requirements: A current Plan of Operation was reviewed. The facility has a Dementia Waiver in place. A Hospice Waiver for one (1) is approved. Facility has a fire clearance for 6 non-ambulatory adults 60 and over, of which one (1) may be bedridden. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate expired 7/13/2023. Licensee has not renewed policy since there are zero (0) residents in care. A surety bond is not applicable. Facility does not handle resident's money. ***Narrative continues next page.**** Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood consisting of 3 resident bedrooms, 2 staff bedrooms, living room, dining room, kitchen, laundry room, 3 bathrooms, backyard patio area, detached garage, and a building/ ADU (Additional Dwelling Unit) in the rear of the property. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the backyard. Exit doors are free of any obstruction. The facility has one two (2) fully charged fire extinguishers, operable smoke and carbon monoxide detectors. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Staffing: The facility is owner operated. Criminal Background Clearance was checked. It presently does not have any residents in care. Personnel Records/Staff Training: Administrator certificates expires 5/10/2024. Personnel files/training were reviewed. Proof of staff training, health clearance, criminal background clearance and 1st Aid/CPR training was observed in staff files. Resident Records/Incident Reports: No resident files were reviewed. There are no residents in the home. RCFE complaint poster and Personal rights were observed posted. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Sanitation practices and kitchen cleanliness was observed. Incident Medical and Dental: Centrally stored medicines are kept safe and locked in hallway closet. No resident medications were reviewed. Medical and dental transportation is provided by family members and 3rd party transportation services. Disaster Preparedness: Emergency and Disaster Plan LIC 610D was reviewed and is updated. The last emergency disaster drill was conducted on 1/2/2024. 1st Aid Kit & Manual were observed. Residents with Special Health Needs: No residents are in care. Therefore, there is no home health or hospice care in place. Bedrooms contained mandated furniture/linens, and bathrooms are clean and operational. No deficiencies were cited. Exit interview was conducted with Administrator Adriana Kiss. A copy of the report was not issued due to printing issues. LPA will mail a copy to Licensee.the state’s words, verbatim · CDSS document, Jan 9, 2024