The Norma J's Home for the Elderly II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility unannounced to conduct a required annual visit. Upon arrival, LPA was greeted by staff and Administrator. Reason for the visit was explained. . The LPA and staff / Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. BEDROOMS: There are seven (7) total bedrooms in the facility; six (6) bedrooms are designated as private, single occupancy, resident rooms and one (1) staff room. The staff rooms are kept locked at all times and observed to be occupied by staff. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are four (4) total restrooms. Two (2) are designated as a shared / common resident restrooms, and two (2) are designated as private resident restrooms. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in all the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 115.5 - 119.3 degrees Fahrenheit, all within the required range. LPA observed two (2) storage space closets in the hallway containing extra clean linens and towels for resident use. KITCHEN: The LPA inspected the kitchen/food service area. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. Cleaning supplies and other chemicals are kept locked under the sink and garage inaccessible to residents in care. (Continue to LIC809c) GARAGE: LPA observed the locked garage adjacent to the kitchen. Garage has a washer and dryer and locked cleaning supplies. LPA observed a sufficient supply of emergency food, water, and Personal Protective Equipment (PPE). COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. Smoke / carbon monoxide detectors and fire doors were tested and functioned properly at the time of the visit. The fire extinguisher was observed and fully charged on 10/26/2025. The emergency exiting plans/sketch are posted at the entrance. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place in 6/7/2026 and are conducted quarterly. Activities were observed in the common areas. The fireplace in the living room was adequately screened and non operational. There is a functioning telephone on the premises. LPA observed surveillance cameras installed in the common areas of the facility with video capability only. BACKYARD: The entire property is fenced. The backyard has a covered patio area with shade, patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed one (1) self-latching gate. There were no bodies of water noted at the time of the visit. Only 1 (one) pathway is used as an emergency exit which was free of obstructions at the time of the visit. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. The facilities policies and procedures, as they pertain to infection control and emergency planning, adhere to the regulations. LPA requested Administrator/Licensee to submit a current LIC 500 Personnel report and copy of the Limited Liability insurance. Due to time constrain, annual visit will continue to another day to review facility records and medication records and procedures. No deficiency cited during today's visit. Exit interview conducted and copy of report issued.the state’s words, verbatim · CDSS document, Aug 26, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9:55 a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The Manager, Robin Douglas and Administrator/Licensee Representative, Loretta Tiede arrived shortly after and the reason for the visit was explained. Entrance interview. The LPA and staff / Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREAS: This includes two (2) living rooms, salon, and dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 10:45 a.m., hardwire combination of smoke / carbon monoxide detectors and fire doors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 10/24/2024. The emergency exiting plans/sketch are posted at the entrance. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 08/15/2025 and are conducted quarterly. Activities were observed in the common areas. The fireplace in the living room was adequately screened and non operational. There is a functioning telephone on the premises. LPA observed surveillance cameras installed in the common areas of the facility. The Administrator presented the live monitoring screen to the LPA, confirming that all cameras were functioning properly and that none of them were equipped with audio capability. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... INTERVIEWS: Starting at 10:08 a.m. one (1) staff and two (2) resident interviews were conducted. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interview revealed that no concerns were noted or voiced at the time of the visit. BEDROOMS: There are seven (7) total bedrooms in the facility; six (6) bedrooms are designated as private, single occupancy, resident rooms and one (1) staff room. The staff rooms are kept locked at all times and observed to be occupied by staff. One (1) out of six (6) resident rooms has an exit to the exterior. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are four (4) total restrooms. Two (2) are designated as a shared / common resident restrooms, and two (2) are designated as private resident restrooms. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in all the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 111.1-112.3 degrees Fahrenheit, all within the required range. LPA observed two (2) storage space closets in the hallway containing extra clean linens and towels for resident use. KITCHEN: The LPA inspected the kitchen/food service area at 10:25 a.m. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 111.1 degrees Fahrenheit at 10:31 a.m. Cleaning supplies and other chemicals are kept locked under the sink and garage inaccessible to residents in care. GARAGE: LPA observed the locked garage adjacent to the kitchen. Garage has a washer and dryer and locked cleaning supplies. LPA observed a sufficient supply of emergency food, water, and Personal Protective Equipment (PPE). Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... BACKYARD: The entire property is fenced. The backyard has a covered patio area with shade, patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed one (1) self-latching gate. There were no bodies of water noted at the time of the visit. Only 1 (one) pathway is used as an emergency exit which was free of obstructions at the time of the visit. RECORDS: Personnel Records were reviewed beginning at 10:51 a.m. five (5) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. Resident Records: were reviewed beginning at 11:50 a.m. four (4) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All records were in order. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. The facilities policies and procedures, as they pertain to infection control and emergency planning, adhere to the regulations. MEDICATIONS: Medication review began at approximately 1:15 p.m. Medications are centrally stored and locked in filing cabinets located in the kitchen adjacent to the dining room. Medications for three (3) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed during review. DOCUMENTS: Documents obtained during the visit include: LIC 500 facility roster , LIC 9020A Resident roster and copy of the Limited Liability insurance. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report reviewed and provided.the state’s words, verbatim · CDSS document, Aug 28, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility unannounced to conduct a required annual visit. Upon arrival LPA was greeted by staff and informed them of the reason for the visit. Administrator Loretta Tiede was contacted. Mrs. Tiede stated she is with a resident at an appointment and stated that the lead staff Robin Douglas will assist LPA with the Annual inspection. At approximately 11am, the LPA and staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. BEDROOMS/ BATHROOMS: LPA inspected the bedroom and bathroom areas. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are six designated resident rooms and one staff room. There was a linen closet in the hallway with extra towels and linens. The resident restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature measured between at 115.7 and 116.9 degrees Fahrenheit. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature of 76 degrees. Smoke detector(s) and carbon monoxide detector were tested at 11:25 am and operational at the time of the visit. The fire extinguisher was fully charged and last serviced Oct 11, 2023. The LPA observed required postings throughout the common spaces. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for resident use. There is a side gate for resident use and is single latched. No bodies of water noted and exits are free of obstructions. The garage is attached, locked and inaccessible. Garage is where the washer and dryer are held, including additional refrigerator with perishable food items. Cleaning supplies and disinfectants are kept in locked in the garage. The facility keeps a sufficient amount of emergency food supplies and water in the garage. RECORDS: Residents’ records review began at 11:45 a.m., records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Staff records review began at approximately 1:15pm. (Continue to LIC809c) Staff records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Four staff files including Administrator's file reviewed and observed to be in order. MEDICATIONS: Medications review began at 3p.m.; medications are centrally stored and locked in a filing cabinet in the kitchen dining room. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. LPA observed no PRN authorization letter on file for residents with PRN medication. PRN log records observed on file. No other issues observed during the medication review. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The LPAs obtained the following documents: - LIC500 Personnel Report - Liability Insurance - Updated Disaster Plan No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Aug 27, 2024