Edna Rose Residence

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) De Leon arrived at 10:15 am to conduct a 1 year annual visit to the facility above. LPA met with Back up Administrator, Rachelle Tellez and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Infection Control: The facility has a current Infection Control Plan. The facility has a sign in and out binder for visitors at entry with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs are visible in the guest bathroom. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). Physical Plant & Environment Safety: The fire extinguishers were last charged and inspected on May 13, 2025. The facility has 6 resident bedrooms with bathrooms and 1 guest bathroom. LPA was authorized to enter and inspect facility. The facility dual smoke and carbon monoxide detectors hard wired thorugh out with a sprinkler system. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid mats or textured bottoms. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents locked in the laundry room and supply closet. The facility has sufficient space inside and outside for activities, with outside furniture and shaded areas around the backyard. The facility has a secured perimeter with 6 locked gates, automated entry and exiting gates, 1 lock was broken on gate by tennis court. There are 2 large ponds inaccessible to residents in care with a fully fenced perimeter, the pool and spa is completely fenced with a locked gate for entry and exit. The facility has telephone and internet service for resident use. Cont. 809-C Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 4/29/2026. The facility is approved for a capacity of 6. The fire clearance is granted for 6 Non-Ambulatory 2 of which may be bedridden. Hospice is approved for 6. Staffing: The facility currently employes 4 full time staff, 5 part time staff and 2 Administrators. Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance and education requirements. Administrator Certificate expires March 22, 2024. Personnel Records & Training: The facility keeps confidential files for each staff member. Five Staff files were reviewed on Relias training completed for all subjects/topics and hours for 2025-2026. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, LIC. 602A Physicians report, Appraisals Needs and Services Plan, Emergency and ID forms, all forms were legible and records are kept confidential. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7-day non-perishables and plenty extra, to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Cleaning solutions and equipment are stored separately from food supplies. Kitchen staff are observed for personal hygiene and food sanitation practices. Incidental Medical Services: Facility provides assistance in arranging transportation to medical and dental appointments when needed. Residents have on-call Doctor that visits facility. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed residents’ medications, no labels were altered, no medications were expired and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility uses Hospice and Home Health Services plan are kept current and up to date. The facility does not have delayed egress. The facility does have a secured perimeter with fencing and 6 locked gates. The facility does have exiting door alarms. Continued 809-C LPA interviewed 2 staff and 2 residents. Exit interview conducted, deficiency cited, copy of report and appeal rights printed for Administratorthe state’s words, verbatim · CDSS document, Mar 6, 2026

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) De Leon conducted a Case Management Incident Visit to the facility above. LPA met with Jessica Bailey and explained the purpose of the visit. Administrator called in incident report immediately to LPA on 04/10/2025 and will follow up with written incident report. The incident was cross reported to the Long Term Care Ombudsman (LTCO) office and law enforcement. LPA De Leon requested the following records: Resident 1 (R1) Incident Report LIC. 602A Physicians report, Appraisal Needs and Services Plan, Medication List and emergency ID and contact form. LPA De Leon conducted interview with staff caregivers, Administrator and resident. LPA may return at a later date if citations are warranted. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Apr 11, 2025

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) De Leon conducted a continuation annual to the facility above to complete the 1 year annual visit. LPA met with Back up Administrator Jessica Bailey and explained the purpose of the visit. LPA toured the inside and outside of the facility and the following was noted. Infection Control: The facility has a current Infection Control Plan. The facility has a sign in and out binder for visitors at entry with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs are visible in the guest bathroom. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). Physical Plant & Environment Safety: The fire extinguishers were last charged and inspected on 05/20/2024. the facility is a two-story home with an elevator and stairwell. The facility has 6 resident bedrooms with on suite bathrooms and 1 common area restroom. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid mats or textured bottoms. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care land are locked in the laundry room. The facility has sufficient space inside and outside for activities and visiting. The facility has a gated backyard for client use with plenty of shade. There is a pond, pool and spa that are secured with fencing, locked gates, secured perimeter and inaccessible to residents. The facility has telephone and internet service for resident use. The facility does have video surveillance in the inside and outside common areas of the facility. Continued 809-C Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 4/29/2026. The facility is approved for a capacity of 6. The fire clearance is granted for 6 Non-Ambulatory, 2 of which may be bedridden. Hospice waiver is approved for 6. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7-day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Cleaning solutions and equipment are stored separately from food supplies. Kitchen staff are observed for personal hygiene and food sanitation practices. Incidental Medical Services: Facility provides assistance in arranging transportation to medical and dental appointments when needed. Residents have on-call Doctor that visits facility. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed residents’ medications, no labels were altered, no medications were expired and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. The facility has an emergency evacuation chair for the stairwell. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility does accept Hospice and Home Health Services. The facility does not currently have any residents on Hospice Services. The facility currently has 3 residents receiving Home Health services. The facility does not currently have any residents on oxygen. Hospice and Home Health plan are kept current and up to date on reisdnets receiving those services. The facility does have a secured perimeter. The facility does have exiting door alarms for the safety of residents in care. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Apr 11, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) De Leon conducted a 1 year Annual visit to the facility above. LPA met with Rachelle Tellez and explained the purpose of the visit. LPA De Leon went to the centralized office for the facility to conduct the file reviews. Staffing: The facility currently employes 7 staff and 3 Administrators. Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, and Criminal Record statements. Administrator Certificates expires August 2026. Personnel Records & Training: The facility keeps confidential files for each staff member. Staff have annual training completed for all subjects/topics and 20 plus hours for 2024-2025. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, Physician’s reports Pre-appraisals, Appraisals Needs and Services Plan, Emergency and ID forms, all forms were legible and records are kept confidential. Due to time constraints LPA will return at a later date to finish the annual visit. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Mar 26, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Miller arrived at 11:00 am to conduct a 1 year annual visit to the facility above. LPA met with Administrator, Jessica Bailey and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Infection Control: The facility has a current Infection Control Plan. The facility has a sign in and out binder for visitors at entry with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs are visible in the guest bathroom. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). All trash cans and wastebaskets have tight fitting covers. Physical Plant & Environment Safety: The fire extinguishers were last charged and inspected on May 22, 2023. The facility has 6 resident bedrooms with ensuite bathrooms and 1 guest bathroom. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors that were tested and working properly during visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid mats or textured bottoms. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care land are locked in the laundry room. The facility has sufficient space inside and outside for activities and visiting. The facility has a gated backyard for client use with plenty of shade. There is a pond, pool and spa that are secured with a gate and inaccessible to residents. The facility has telephone and internet service for resident use. Continued 809-C Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 4/29/2024. The facility is approved for a capacity of 6. The fire clearance is granted for 6 Non-Ambulatory 2 of which may be bedridden. Hospice is approved for 6. Staffing: The facility currently employes 4 full time staff, 5 part time staff and 2 Administrators. Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance and education requirements. Administrator Certificate expires March 22, 2024. Personnel Records & Training: The facility keeps confidential files for each staff member. Staff have annual training completed for all subjects/topics and hours for 2023. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, LIC. 602A Physicians report, Appraisals Needs and Services Plan, Emergency and ID forms, all forms were legible and records are kept confidential. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7-day non-perishables and plenty extra, to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Cleaning solutions and equipment are stored separately from food supplies. Kitchen staff are observed for personal hygiene and food sanitation practices. Incidental Medical Services: Facility provides assistance in arranging transportation to medical and dental appointments when needed. Residents have on-call Doctor that visits facility. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed residents’ medications, no labels were altered, no medications were expired and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility currently has 2 residents receiving Home Health services. The facility does not have delayed egress, locked doors or gates. Exit door alarms are working. Exit interview conducted and copy of report printed for Administratorthe state’s words, verbatim · CDSS document, Mar 4, 2024