Agate Homecare

Type of visit: Case Management - Licensee Initiated

On 04/30/2025 at 10:15 AM, Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to confirm that there are no residents at the home for the facility's closure. LPA Hernandez was granted entrance by Licensee/Administrator Brooke Simm. LPA Hernandez was informed that there are no clients living in the facility. The licensee is initiating this closure. LPA inspected the entire facility which included the bedrooms, bathrooms, dining area, kitchen, and the backyard. There were no residents present, and there were no belongings of residents in the facility. Moreover, Licensee/Administrator Simm stated that the reason of the closure is due to the facility being converted into a congregated facility. During today's visit, the licensee surrendered the original license to LPA Hernandez. The effective date of closure will be 04/30/2025. An exit interview was conducted where this report, LIC809 was discussed with and provided to Licensee/Administrator Brooke Simm.the state’s words, verbatim · CDSS document, Apr 30, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Bianca Wolcott conducted an announced visit to the facility for the purpose of verifying corrections from the intial Pre-Licensing inspection on February 22, 2024. At approximately 9:00 AM, LPA was greeted and granted entry by Administrator Brooke Sanasinh. LPA observed the following: Non-ambulatory residents were changed by physicians report signed 2/28/24 to ambulatory residents, this was confirmed by viewing physicians report signature page included and touring the facility and inspecting all residents bedrooms. LIC 602 Admission agreement completed for all residents. Updated Physician's report for residents diagnosed with dementia. Pre-licensing is now complete. Final licensor will be determined by Central Application Bureau (CAB). Administer completed COMP III online with Administrator. An exit interview was conducted and a copy of this report provided electronically.the state’s words, verbatim · CDSS document, Mar 22, 2024

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) and Bianca Wolcott and Anna Bueno made a visit to the facility for the purpose of conducting a pre-licensing inspection visit. LPAs met with Administrator Simm Sanasinh. LPAs and Administrator toured the facility inside and out. The pending initial application is for a change of ownership a Residential Care Facility for the Elderly/Dementia (RCFE). Fire Clearance inspection was completed on 7/13/2023 and the property has been granted a fire clearance for a maximum capacity of six (6) which are two (2) ambulatory residents and four (4) non ambulatory only. Facility is a single story home with 5 bedrooms, 3 bathrooms, living room, dining room, and kitchen. There are no bodies of water. Appropriate patio furniture was present. LPAs observed proper required accommodations in resident bathrooms. Smoke detectors were operable. Carbon monoxide device was operable. Fire extinguisher are charged and last purchased on 12/03/2023. Hot water is kept at 104 degrees F. LPAs observed required postings including Resident's Personal Rights, the Department's complaint poster, the Ombudsman's poster, and the facility's emergency/disaster plan. The kitchen area was observed for the ability to serve food and maintained cleanliness. Temperatures for refrigerator is at 40 degrees and freezer was at 0 degrees. Dishes, utensils, glasses are present and in working order. Dishwasher will be used to clean and sanitize dishes. LPAs observed 2 days of perishable food items and 7 days of non perishable goods. Bedrooms have the required furnishings and sufficient storage space and lighting. Facility has an adequate supply of linens and towel. Medication and resident and staff files will be stored in a locked cabinet and a locked cabinet for medications. One complete first aid kit was observed in the kitchen. CONTINUED ON LIC812-C LPAs did not observe any potential hazards within the facility at the time of visit. The property appears to be in good repair and safe for resident use. The facility currently has six (6) clients in care, two (2) ambulatory and four (4) non-ambulatory of which are elderly. The following corrections need to be performed before the pre-licensing inspection is completed: LIC 602 Admissions agreement needs to be completed for five (5) residents. Non Ambulatory residents will be removed from Ambulatory rooms Updated Physician's report for resident diagnosed with dementia. Continuing record of needed services. An exit interview was conducted where this report was discussed and a copy was provided to Administrator Simm Sanasinh/Administrator.the state’s words, verbatim · CDSS document, Feb 22, 2024