Pedflor's Residential Care II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 12:17 pm to conduct a 1-year annual visit to the facility above. LPA met Administrator Aurea Alejandro and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: The facility has 4 bedrooms and 2 bathrooms, with 1 bedroom dedicated to staff. The facility occupies 2 residents and employs 3 staff of which one is the Administrator and back-up are available if needed. The facility has smoke and carbon monoxide detectors; both were tested and were working at the time of visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort and safety. The facility kitchen is clean, safe and sanitary. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Disinfectants, cleaning solutions and poisons are inaccessible to residents in care. The facility has sufficient space inside and outside for activities and visiting. Operational Requirements: The facility has a current plan of operation on file. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 02/28/2027. The facility is approved for a capacity of 6 non-ambulatory of which 1 may be bedridden. Staffing/Personnel Records & Training: Staff records are kept confidential. LPA reviewed 3 staff files. Files reviewed were kept up to date with all requirements. LPA reviewed training records for Annual Training Requirements, all required annual training was documented. Administrator Certificate expires 3/11/28. Continued 809-C Resident Records & Incident Reports: Two files were reviewed for signed Admission Agreements, Medical Assessments, LIC. 602A Physicians Report, ID and Emergency contact forms, TB results, Pre-appraisal, and Safeguard for personal property and valuables. Incidental Medical & Dental: The facility has a medication cabinet which was and is kept locked. The medications records were reviewed and all residents in care had a Medication Administration Record (MAR) and a Centrally Stored Medication Destruction Record (CSMDR). LPA inspected all residents medication and PRN medications. PRN logs and authorization forms were present. No medications labels were altered, and no expired medications. Food Service: The facility has 2-day perishables and 7 day non-perishables to meet the food service requirement. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available. Kitchen areas are kept clean and free from litter, rodents, and insects. Disaster Preparedness: The current emergency disaster forms were posted, LPA reviewed and collected current copy of plan. The facility conducts quarterly disaster drills. The fire extinguisher was charged. Emergency exits and telephone numbers were posted. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or in accessible to residents in care. The facility does not have delayed egress. The facility does has one resident on PRN Oxygen which a notification for the fire department was recorded in their file. There is one resident on hospice and one resident with home health services. The facility gates are self-closing and self-latching. The backyard is completely fenced. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Apr 2, 2026

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Rankin arrived at the facility announced at 3:03 p.m. to conduct a pre-licensing inspection. LPA met with Administrator Aurea Alejandro. This is a change of ownership application from Pedflor Alejandro, LLC. to Pedflor Alejandro I LLC. The current census is three (3) residents. The fire clearance was granted on 12/18/24; in which two (2) rooms were cleared for non-ambulatory residents and one (1) room for bedridden residents. Component III was reviewed with administrator for Residential Care Facility for the Elderly (RCFE)’s. The LPA toured the physical plant areas inside and outside with the applicant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. BEDROOMS: There are four (4) bedrooms in the facility; the facility has three (3) rooms for resident use, and one (1) staff room. Staff room is kept locked. All resident rooms have doors to the outside. Lighting in the rooms appeared adequate. All rooms were set up with beds, night stands, lamps, chests of drawers, chairs and closet space. BATHROOMS: There is two (2) full bathrooms for resident use. The bathroom in the hallway is designated for staff and resident use, one (1) bathroom is in a private room designated for resident use. The showers are equipped with nonskid surfaces and available nonskid mats. Grab bars were observed in the bathrooms. Continued on LIC 809-C. COMMON AREA: The common areas were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment in the living room area. The facility smoke alarm system was tested and working at time of visit. There is a charged fire extinguisher located in the living room area. Last inspected in August of 2024. There is a functioning telephone on the premises. Emergency exiting plans/sketch are posted. Emergency telephone numbers are posted. All other required postings are also posted in the hall and common areas. KITCHEN: Kitchen knives are stored locked and inaccessible in a drawer on the left side of the kitchen sink. The supply of perishable and nonperishable food is adequate. The supply of dishes is adequate. Appliances in the kitchen are clean and functional. There is an adequate supply of emergency food. MEDICATIONS: Medications are in a locked cabinet in the kitchen. The first aid supplies were complete. FILES: Resident and staff records were reviewed and complete. LAUNDRY: The laundry area is located in the attached garage. Laundry detergent and chemicals are locked and stored inaccessible. EXTERIOR: The exterior passageways were clean and clear of any obstructions. The backyard is set up with a table, which is located under a shaded structure along with chairs for resident use. There are no bodies of water noted on the premises. The back and sides of the house are separated from the front yard by gates. Gates have a self-latching mechanism. There are no other structures on the property. INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. If needed, the facility has the capacity to designate a single isolation room if needed. Facility is in compliance with Title 22 Regulations at this time. This report will be sent to the Centralized Application Bureau (CAB). The CAB Analyst will notify the applicant when the license has been approved. The applicant is aware that they are unable to operate under the new license number until they have been notified that the license has been approved by the CAB Analyst. Failure to comply could affect approval of the license. Exit interview conducted and report issued.the state’s words, verbatim · CDSS document, Apr 15, 2025